Provider Demographics
NPI:1720049760
Name:WINICKOFF, JONATHAN PHILIP (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PHILIP
Last Name:WINICKOFF
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Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:40 2ND AVE
Practice Address - Street 2:STE 400 MASS GENERAL WEST MEDICAL GROUP WALTHAM
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-522-9000
Practice Address - Fax:781-522-9095
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA205857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22483OtherBCBS MA
MA0100650Medicaid
MA205857OtherTUFTS HEALTH PLAN
MA0100650Medicaid
MA205857OtherTUFTS HEALTH PLAN