MEDICARE: LEOCADIA T PRAWDZIK 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	MD039665L	PA

General Provider Information

NPI Number	:	1346218104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEOCADIA T PRAWDZIK MD

Provider Business Mailing Address
First Line	:	1090 N CHURCH ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-1446
Country	:	US
Telephone Number	:	570-459-1485
Fax Number	:	570-459-6354

Provider Business Practice Location Address
First Line	:	1090 N CHURCH ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18202-1446
Country	:	US
Telephone Number	:	570-459-1485
Fax Number	:	570-459-6354

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/17/2009

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