Active NPI
Edmund Paul Tkaczuk, MD
- Internal Medicine Physician
- Pasadena, MD
National Provider Identifier
1306827696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- D34951
- Practice address
- 7675 Colonial Beach Rd
Pasadena, MD 21122-3206 - Phone
- (443) 537-3299
- Fax
- (410) 360-4699
- NPI assigned
- Nov 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D34951 | MD | Primary |
Addresses
Primary practice location
7675 Colonial Beach Rd
Pasadena, MD 21122-3206
Mailing address
7675 Colonial Beach Rd
Pasadena, MD 21122-3206
Phone (443) 537-3299
Other practice location 1
6501 Baltimore National Pike Ste D
Catonsville, MD 21228-3923
Phone (667) 234-2100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 477971100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D34951 | MD | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655856000000",
"number": "1306827696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7675 COLONIAL BEACH RD",
"city": "PASADENA",
"state": "MD",
"postal_code": "211223206",
"telephone_number": "443-537-3299",
"fax_number": "410-360-4699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7675 COLONIAL BEACH RD",
"city": "PASADENA",
"state": "MD",
"postal_code": "211223206",
"telephone_number": "443-537-3299",
"fax_number": "410-360-4699"
}
],
"practiceLocations": [
{
"address_1": "6501 Baltimore National Pike Ste D",
"address_purpose": "LOCATION",
"city": "Catonsville",
"state": "MD",
"postal_code": "212283923",
"country_code": "US",
"telephone_number": "667-234-2100",
"fax_number": "667-234-2944",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TKACZUK",
"first_name": "EDMUND",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-14",
"last_updated": "2022-06-22",
"certification_date": "2022-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MD",
"license": "D34951",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "477971100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.