Provider Demographics
NPI:1205940533
Name:WINIECKI, MARC A (DO)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:WINIECKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PETERBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5860
Mailing Address - Country:US
Mailing Address - Phone:603-532-8775
Mailing Address - Fax:603-532-7482
Practice Address - Street 1:82 PETERBOROUGH ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-5860
Practice Address - Country:US
Practice Address - Phone:603-532-8775
Practice Address - Fax:603-532-7482
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH001277301OtherMEDICARE PTAN
NH30227627Medicaid