Provider Demographics
NPI:1629053970
Name:VYTVYTSKA-DIENHART, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:VYTVYTSKA-DIENHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:VYTVYTSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 GENERAL ST
Mailing Address - Street 2:ANDREA SULLIVAN-DIRECTOR OF MANAGED CARE
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2961
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:978-946-8017
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:ANDREA SULLIVAN-DIRECTOR OF MANAGED CARE
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:978-946-8017
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71324207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE69003Medicare UPIN