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Jacek Lech Mostwin

Urology

Allopathic & Osteopathic Physicians

601 N Caroline St, Baltimore, MD 21287-0006

PECOS Enrollment

This provider is enrolled in PECOS as JACEK MOSTWIN.

Based on the most recent information from CMS, provider Jacek Lech Mostwin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1487607149
Provider Type
Individual
Full Name
Mostwin, Jacek Lech
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/17/2006
Last Updated
2/13/2013

Contact Information

Practice Location

601 N Caroline St, Baltimore, MD 21287-0006

(410) 955-6100

Unlisted Fax

Mailing Location

PO Box 64255, Baltimore, MD 21264-4255

(410) 955-6100

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208800000X Primary	Description Urology Allopathic & Osteopathic Physicians	License D21971 Maryland

Provider Identifiers

ID	Description	Issuer
ID 382191900	Description Medicaid	Issuer Unlisted Maryland

Jacek Lech Mostwin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Dodson, Jennifer Lockwood

Wang, Ming Hsien

Carter, Herbert Ballentine

Crigger, Chad

Allaf, Mohamad E

Singla, Nirmish

Nelson, Caleb P

Winoker, Jared S

Stutzman, Ray

Gearhart, John P