Provider Demographics
NPI:1811045560
Name:WOSK, FRIDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:FRIDA
Middle Name:R
Last Name:WOSK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7 ELIOT ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2724
Mailing Address - Country:US
Mailing Address - Phone:617-524-2024
Mailing Address - Fax:
Practice Address - Street 1:435 WARREN ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1833
Practice Address - Country:US
Practice Address - Phone:617-442-7400
Practice Address - Fax:617-427-8263
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1581272080A0000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303961Medicaid
MA1303961Medicaid