Provider Demographics
NPI:1003806902
Name:WYCHOWSKI, ADAM GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GREGORY
Last Name:WYCHOWSKI
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 1:3640 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1084
Mailing Address - Country:US
Mailing Address - Phone:413-733-0669
Mailing Address - Fax:413-739-0621
Practice Address - Street 1:3640 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1192
Practice Address - Country:US
Practice Address - Phone:413-739-0669
Practice Address - Fax:413-739-0621
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223722208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2105276Medicaid
MA470306OtherTUFTS HEALTH PLAN
MA36483OtherHEALTH NEW ENGLAND
MAJ28919OtherBLUE CROSS BLUE SHIELD MA
MAA38855Medicare ID - Type Unspecified
MA2105276Medicaid