Basic Information
| Provider Information | |||||||||
| NPI: | 1497758056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CZARNECKI | ||||||||
| FirstName: | FABRICE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 GLEN EAGLES CT STE 101 | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212862204 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7601 OSLER DR | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103371226 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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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 | 207Q00000X | D0061528 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083X0100X | 036.130147 | IL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 207Q00000X | 036.130147 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | D0061528 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.