Individual
LANE AUSTIN WALKOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1400 VFW PKWY, WEST ROXBURY, MA 02132-4927
(617) 323-7700
Mailing address
1400 VFW PKWY, WEST ROXBURY, MA 02132-4927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA4443
MA
363AS0400X
Surgical Physician Assistant
Primary
PA4443
MA
Other
Enumeration date
09/06/2012
Last updated
04/04/2016
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