MEDICARE: DR. DOLORES V DACZKOWSKI D.O.

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	OS004297L	PA

General Provider Information

NPI Number	:	1821043662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOLORES V DACZKOWSKI D.O.

Provider Business Mailing Address
First Line	:	709 DOMINION DR
Second Line	:
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-4404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7335 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3929
Country	:	US
Telephone Number	:	215-335-1220
Fax Number	:	215-335-2517

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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