Provider Demographics
NPI:1609833516
Name:ZGLESZEWSKI, TIMOTHY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:ZGLESZEWSKI
Suffix:
Gender:
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:PO BOX 7227
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-7227
Mailing Address - Country:US
Mailing Address - Phone:803-218-9886
Mailing Address - Fax:803-470-4715
Practice Address - Street 1:2679 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9100
Practice Address - Country:US
Practice Address - Phone:843-573-9997
Practice Address - Fax:803-470-4715
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA780012081P2900X, 208VP0014X
SC229122081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400863Medicaid
SCT71703Medicaid
SC400863Medicaid
SCT71703Medicaid
SC7684Medicare PIN