Provider Demographics
NPI:1033133012
Name:WISSNER, BARBARA P (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:P
Last Name:WISSNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:747 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-371-2098
Mailing Address - Fax:978-371-2098
Practice Address - Street 1:747 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-371-2098
Practice Address - Fax:978-371-2098
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA584852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA058485OtherTUFTS HEALTH PLAN
MA0017351OtherNEIGHBORHOOD HEALTH PLAN
MAJ08421OtherBLUE CROSS
MACA0363OtherMEDICARE PTAN
MA058485OtherTUFTS HEALTH PLAN
MA0017351OtherNEIGHBORHOOD HEALTH PLAN