Provider Demographics
NPI:1093081549
Name:WIWAT, P.C.
Entity Type:Organization
Organization Name:WIWAT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-245-1223
Mailing Address - Street 1:10 RICHARDSON AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2913
Mailing Address - Country:US
Mailing Address - Phone:781-245-1223
Mailing Address - Fax:
Practice Address - Street 1:10 RICHARDSON AVE
Practice Address - Street 2:UNIT A
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2913
Practice Address - Country:US
Practice Address - Phone:781-245-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA768692083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110053491AMedicaid
F57525Medicare UPIN