Provider Demographics
NPI:1861403065
Name:SZEWCZYK, DAMIAN T (MD)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:T
Last Name:SZEWCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2401
Mailing Address - Country:US
Mailing Address - Phone:931-967-3966
Mailing Address - Fax:931-962-0373
Practice Address - Street 1:83 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2401
Practice Address - Country:US
Practice Address - Phone:931-967-3966
Practice Address - Fax:931-962-0373
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD035196208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37164461OtherMEDICARE GROUP
TN4158382OtherBCBS GROUP #
TN2523522OtherICIGNA INDIVIDUAL #
TN38620811Medicaid
TNP00238216OtherRAILROAD MEDICARE IND #
TN37164461OtherMEDICAID GROUP #
TN7123231OtherAETNA
TN4154842OtherBCBS IND #
TN7123231OtherAETNA
TN38620811Medicaid