Provider Demographics
NPI:1205096328
Name:WITKOWSKI, ELAN (MD)
Entity type:Individual
Prefix:
First Name:ELAN
Middle Name:
Last Name:WITKOWSKI
Suffix:
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 1:15 PARKMAN ST
Mailing Address - Street 2:WANG ACC 460
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-643-8606
Mailing Address - Fax:617-724-1117
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WANG ACC 460
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-8606
Practice Address - Fax:617-724-1117
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA245487208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery