Individual
CHARLES AUGUST WASICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
145 CLINTON STREET, WATERTOWN, NY 13601
(315) 782-5523
(315) 782-0549
Mailing address
145 CLINTON STREET, WATERTOWN, NY 13601
(315) 782-5523
(315) 782-0549
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
122206
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00875434MC
—
NY
Enumeration date
11/14/2006
Last updated
05/19/2011
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