Provider Demographics
NPI:1730392390
Name:ANDRZEJ J STANKIEWICZ MD PHD LTD
Entity type:Organization
Organization Name:ANDRZEJ J STANKIEWICZ MD PHD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRZEJ
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:401-456-3064
Mailing Address - Street 1:200 HIGH SERVCE AVENUE
Mailing Address - Street 2:MARIAN HALL 2ND FLOOR
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5113
Mailing Address - Country:US
Mailing Address - Phone:401-456-3064
Mailing Address - Fax:401-752-8247
Practice Address - Street 1:200 HIGH SERVCE AVENUE
Practice Address - Street 2:MARIAN HALL 2ND FLOOR
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5113
Practice Address - Country:US
Practice Address - Phone:401-456-3064
Practice Address - Fax:401-752-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI7157207R00000X
MAMA57821207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4549OtherBCBS
792298OtherUSFNP
004304OtherBLUE CHP
0405194OtherUNITED DEATH
RI9000454Medicaid
=========OtherTRICARE
RI9000454Medicaid