Individual
DR. JACK WITTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, FND 2, BOSTON, MA 02114-2621
(617) 726-8396
(617) 726-4891
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 726-8380
(617) 726-4891
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28711
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0194255
—
MA
01
—
725096
TUFTS HEALTH PLAN
MA
01
—
M07089
BCBS MA
MA
Enumeration date
11/02/2005
Last updated
08/30/2012
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