Provider Demographics
NPI:1033173091
Name:JOSELOW, WANE G (MD)
Entity Type:Individual
Prefix:DR
First Name:WANE
Middle Name:G
Last Name:JOSELOW
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 1:61 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-1666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6768
Practice Address - Country:US
Practice Address - Phone:603-668-7096
Practice Address - Fax:603-669-6944
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH71222085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001058Medicaid
NH0105455Y0 NH06OtherANTHEM MCH TAX ID
NH007122OtherTUFTS
NE0105455Y0NH03OtherBLUE CROSS
NH2176872OtherAETNA
NH2781OtherCIGNA
NHB86184Medicare UPIN
NH30001058Medicaid