Basic Information
| Provider Information | |||||||||
| NPI: | 1194817759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLOCIENNIK | ||||||||
| FirstName: | KRZYSZTOF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 PAGE HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522200 | ||||||||
| FaxNumber: | 6033265999 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 PAGE HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522200 | ||||||||
| FaxNumber: | 6033265999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 14636 | NH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 042-0009852 | VT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00049367 | 01 | VT | BCBS | OTHER | 15V305 | 01 | VT | MVP | OTHER | 4675801 | 01 | UT | VERMONT MANAGED CARE APEX | OTHER | 420001577 | 01 | VT | TRAVELERS MEDICARE | OTHER | 0VN2990 | 05 | VT | MEDICAID | 8000477 | 01 | VT | LADIES FIRST | OTHER |