Individual
DR. TAD J WIECZOREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1153 CENTRE ST, DEPT OF PATHOLOGY, FAULKNER HOSPITAL, JAMAICA PLAIN, MA 02130-3446
(617) 983-7666
(617) 983-7736
Mailing address
1153 CENTRE ST, DEPT OF PATHOLOGY, FAULKNER HOSPITAL, JAMAICA PLAIN, MA 02130-3446
(617) 983-7663
(617) 983-7736
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
Primary
160676
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0145301
—
MA
Enumeration date
04/17/2006
Last updated
12/09/2010
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