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Individual

DR. PHILIP WISOTSKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11350 PEMBROOKE SQ STE 311, WALDORF, MD 20603-4809
(301) 870-0660
(301) 932-8310
Mailing address
11350 PEMBROOKE SQ STE 311, WALDORF, MD 20603-4809
(301) 870-0660
(301) 932-8310

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D18545
MD
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
D18545
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110167788
RR MEDICARE
05
960821400
MD
Enumeration date
06/23/2005
Last updated
11/19/2021
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