Basic Information
| Provider Information | |||||||||
| NPI: | 1033314000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRZYWACZ | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 S 25TH ST | ||||||||
| Address2: | APT # 215 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191036002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159649466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | A. I. DUPONT HOSPITAL FOR CHILDREN | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026515874 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C70003827 | DE | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MT 190968 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.