Provider Demographics
NPI:1396753307
Name:WOLPOWITZ, DEON (MD)
Entity type:Individual
Prefix:DR
First Name:DEON
Middle Name:
Last Name:WOLPOWITZ
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 1:10 LAUREL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-7536
Mailing Address - Country:US
Mailing Address - Phone:781-235-8155
Mailing Address - Fax:781-235-2855
Practice Address - Street 1:10 LAUREL AVE STE 300
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-235-8155
Practice Address - Fax:781-235-2855
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222940207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073784AMedicaid
MA000032501Medicare PIN