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Individual

RICHARD A WISEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
140 HOSPITAL DR STE 108, BENNINGTON, VT 05201-5010
(024) 447-5519
(802) 447-5657
Mailing address
140 HOSPITAL DR STE 108, BENNINGTON, VT 05201-5010
(802) 447-5519
(802) 447-5657

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
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