MEDICARE: DR. EDMUND PAUL TKACZUK MD

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	207R00000X	Internal Medicine Physician	D34951	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306827696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUND PAUL TKACZUK MD

Provider Business Mailing Address
First Line	:	7675 COLONIAL BEACH RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-3206
Country	:	US
Telephone Number	:	443-537-3299
Fax Number	:	410-360-4699

Provider Business Practice Location Address
First Line	:	7675 COLONIAL BEACH RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-3206
Country	:	US
Telephone Number	:	443-537-3299
Fax Number	:	410-360-4699

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	06/22/2022

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