Provider Demographics
NPI:1831583368
Name:WITKIN, ARIANA M (MD)
Entity type:Individual
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First Name:ARIANA
Middle Name:M
Last Name:WITKIN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:BMC PROVIDER ENROLLMENT OFFICE
Mailing Address - Street 2:960 MASSACHUSETTS AVE,.2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:850 HARRISON AVE.
Practice Address - Street 2:4TH YACC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-4363
Practice Address - Fax:617-499-5103
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2024-04-17
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Provider Licenses
StateLicense IDTaxonomies
MA276725208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110146235AMedicaid