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NPI Code Detail

MEDICARE: DR. EDWARD DZIELAK DO

MEDICARE: DR. EDWARD DZIELAK DO
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
1207R00000XInternal Medicine PhysicianOS004141LPA
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianOS004141LPA

Other Identifiers

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

General Provider Information

NPI Number : 1386611440
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD DZIELAK DO
Provider Business Mailing Address
First Line : 501 S WASHINGTON AVE STE 1000
Second Line :
City : SCRANTON
State : PA
Zip : 18505-3814
Country : US
Telephone Number : 570-343-2383
Fax Number : 570-343-3923
Provider Business Practice Location Address
First Line : 5 S WASHINGTON AVE
Second Line :
City : JERMYN
State : PA
Zip : 18433-1121
Country : US
Telephone Number : 570-230-0019
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 03/10/2022

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Directions to “ DR. EDWARD DZIELAK DO” Practice Location

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