Provider Demographics
NPI:1861452294
Name:SLIWKOWSKI, JOSEPH J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:SLIWKOWSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MOUNT ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1981
Mailing Address - Country:US
Mailing Address - Phone:508-251-7262
Mailing Address - Fax:508-251-7265
Practice Address - Street 1:5 MOUNT ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1981
Practice Address - Country:US
Practice Address - Phone:508-251-7262
Practice Address - Fax:508-251-7265
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051636A207Q00000X, 2083X0100X
MA743112083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000528705OtherANTHEM PROVIDER NUMBER
IN200264480Medicaid
IN224390FFMedicare PIN
IN815460PPPPMedicare PIN
IN921480CMedicare PIN
IN815010HMedicare ID - Type Unspecified
IN200264480Medicaid
IN815500G5Medicare PIN