Provider Demographics
NPI:1487645495
Name:WOLEJKO, RAYMOND EDWARD
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:EDWARD
Last Name:WOLEJKO
Suffix:
Gender:M
Credentials:
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 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST
Practice Address - Street 2:SUITE 230
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5783
Practice Address - Country:US
Practice Address - Phone:978-342-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13898OtherFALLON
MA64688OtherHARVARD PILGRIM
MA110225328OtherUNITED HEALTHCARE
MA0123757Medicaid
MA045633OtherTUFTS
MAE16125OtherBLUECROSS
MA3422217OtherCIGNA
MA0123757Medicaid
MA64688OtherHARVARD PILGRIM