MEDICARE: FABRICE CZARNECKI 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	207Q00000X	Family Medicine Physician	D0061528	MD
2	2083X0100X	Occupational Medicine Physician	036.130147	IL
3	207Q00000X	Family Medicine Physician	036.130147	IL
4	207P00000X	Emergency Medicine Physician	D0061528	MD

General Provider Information

NPI Number	:	1497758056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABRICE CZARNECKI M.D.

Provider Business Mailing Address
First Line	:	809 GLEN EAGLES CT STE 101
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 OSLER DR
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7700
Country	:	US
Telephone Number	:	410-337-1226
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/31/2014

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