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General NPI Number Information
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NPI Number | 1376570572
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Entity Type | Individual
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Provider Name | EDWARD BARCZAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 9012 STONEY POINT RD
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City | CHARLESTOWN
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State | IN
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Zip | 47111-8753
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Country | US
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Telephone | 812-256-2127
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX H
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City | SELLERSBURG
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State | IN
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Zip | 47172-0908
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Country | US
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Telephone | 812-256-2127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01033099
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01033099A
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License Number State | IN
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