Individual
DR. JONATHAN PHILIP WINICKOFF
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD MPH
Contact information
Practice address
40 2ND AVE, STE 400 MASS GENERAL WEST MEDICAL GROUP WALTHAM, WALTHAM, MA 02451
(781) 522-9000
(781) 522-9095
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
205857
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100650
—
MA
01
—
205857
TUFTS HEALTH PLAN
MA
01
—
J22483
BCBS MA
MA
Enumeration date
03/29/2006
Last updated
07/08/2007
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