MEDICARE: DR. JOHN L. LYSZCZARZ III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0101223337	VA

General Provider Information

NPI Number	:	1285611921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN L. LYSZCZARZ III M.D.

Provider Business Mailing Address
First Line	:	PSC 819 BOX 1829
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645-1801
Country	:	US
Telephone Number	:	01134956823408
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 819 BOX 1829
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645-1801
Country	:	US
Telephone Number	:	01134956823408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	10/24/2008

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