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Organization
GERALD A NIEDZWIECKI MD PA
Active
Organization
GERALD A NIEDZWIECKI MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD ANTHONY NIEDZWIECKI MD (PRESIDENT/SHAREHOLDER)
(727) 791-7300
Entity
Organization
Contact information
Practice address
2730 N MCMULLEN BOOTH RD, SUITE 203, CLEARWATER, FL 33761-3302
(727) 286-8929
(727) 286-8933
Mailing address
2730 N MCMULLEN BOOTH RD, SUITE 100, CLEARWATER, FL 33761-3302
(727) 791-7300
(727) 723-9010
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
ME81474
FL
2085R0202X
Diagnostic Radiology Physician
ME0070649
FL
2085R0202X
Diagnostic Radiology Physician
ME81474
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME0070649
FL
2085U0001X
Diagnostic Ultrasound Physician
ME0070649
FL
363A00000X
Physician Assistant
PAT9104325
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600774
UNITED HEALTHCARE
FL
01
—
203364
AVMED
FL
01
—
220039
AMERIGROUP
FL
05
—
250195300
—
FL
01
—
2648373
AETNA HMO
FL
01
—
300123717
RAILROAD MEDICARE
FL
01
—
31439
BCBS
FL
01
—
4593565
AETNA PPO
FL
Enumeration date
02/13/2009
Last updated
05/29/2015
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