Individual
DR. EDMUND PAUL TKACZUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7675 COLONIAL BEACH RD, PASADENA, MD 21122-3206
(443) 537-3299
(410) 360-4699
Mailing address
7675 COLONIAL BEACH RD, PASADENA, MD 21122-3206
(443) 537-3299
(410) 360-4699
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D34951
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
477971100
—
MD
Enumeration date
11/14/2005
Last updated
06/22/2022
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