Individual
VICTORIA WITCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-7846
Mailing address
800 WASHINGTON ST, PO BOX 1013: PROVIDER ENROLLMENT, BOSTON, MA 02111-1552
(617) 636-8153
(617) 636-1465
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA6481
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110139890A
—
MA
Enumeration date
05/10/2018
Last updated
10/15/2018
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