Individual
RICHARD A WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042-0012245
VT
207R00000X
Internal Medicine Physician
159649
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006998
—
VT
05
—
3195228
—
MA
Enumeration date
12/16/2005
Last updated
06/23/2020
Update your record
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