Provider Demographics
NPI:1316023294
Name:WISCOVITCH, MARIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:WISCOVITCH
Suffix:
Gender:F
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 362363
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2363
Mailing Address - Country:US
Mailing Address - Phone:787-655-0505
Mailing Address - Fax:787-655-5059
Practice Address - Street 1:CARRETERA 194 CC21 FAJARDO GARDENS
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-7002
Practice Address - Fax:787-655-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR163012084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR123-16301OtherGLOBAL HEALTH PLAN
PR101145OtherCRUZ AZUL
PR23851 WIOtherTRIPLE-S
PR217109OtherPREFERRED HEALTH
PR7380103OtherHUMANA
PR826134OtherMMM
PRA771OtherIMC
2-3851Medicare ID - Type Unspecified
PRI-51705Medicare UPIN