MEDICARE: DR. RICHARD DWIGHT MARCINIAK 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	27889	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	260049678	OTHER	CO	RAILROAD MEDICARE

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	:	1548202492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD DWIGHT MARCINIAK M.D.

Provider Business Mailing Address
First Line	:	2860 S CIRCLE DR
Second Line	:	SUITE 160
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4113
Country	:	US
Telephone Number	:	719-473-2346
Fax Number	:	719-577-9627

Provider Business Practice Location Address
First Line	:	2860 S CIRCLE DR
Second Line	:	SUITE 160
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4113
Country	:	US
Telephone Number	:	719-473-2346
Fax Number	:	719-577-9627

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	01/18/2011

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