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General NPI Number Information
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NPI Number | 1609833516
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL ZGLESZEWSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2679 LAKE PARK DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9100
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Country | US
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Telephone | 843-573-9997
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Fax | 803-470-4715
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Provider Business Mailing Address
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Address Line | PO BOX 7227
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City | WEST COLUMBIA
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State | SC
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Zip | 29171-7227
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Country | US
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Telephone | 803-218-9886
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Fax | 803-470-4715
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 78001
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 78001
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 22912
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License Number State | SC
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