MEDICARE: DR. TIMOTHY MICHAEL ZGLESZEWSKI 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	78001	GA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	22912	SC
3	208VP0014X	Interventional Pain Medicine Physician	78001	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609833516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MICHAEL ZGLESZEWSKI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7227
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-7227
Country	:	US
Telephone Number	:	803-218-9886
Fax Number	:	803-470-4715

Provider Business Practice Location Address
First Line	:	2679 LAKE PARK DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9100
Country	:	US
Telephone Number	:	843-573-9997
Fax Number	:	803-470-4715

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/28/2026

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