Individual
MR. BRIAN DOMENIC WISHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-7168
(617) 228-4302
Mailing address
3438 BOWMAN ST APT 1, PHILADELPHIA, PA 19129-1509
(516) 297-0530
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OS018121
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/08/2013
Last updated
04/15/2018
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