Provider Demographics
NPI:1437322179
Name:WAWRZYCKI, JOANNA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MARIE
Last Name:WAWRZYCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-553-6920
Mailing Address - Fax:207-553-6940
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-553-6920
Practice Address - Fax:207-553-6940
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420012383207V00000X
MEMD20465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology