Individual
WILLIAM S WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
235 N PEARL ST, ATTN: PATHOLOGY DEPT, BROCKTON, MA 02301-1794
(508) 427-3086
(508) 588-0520
Mailing address
460 TOTTEN POND RD, C/O MZI, WALTHAM, MA 02451-1991
(781) 890-9933
(781) 890-9950
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
57170
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6182089
—
MA
01
—
732320
TUFTS
MA
01
—
AA1347
HPHC
MA
01
—
J03385
BCBS
MA
Enumeration date
11/07/2005
Last updated
03/01/2010
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