Organization
MARC D WISHINGRAD MD INC
Active
Organization
MARC D WISHINGRAD MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC D WISHINGRAD MD (PHYSICIAN)
(310) 453-1871
Entity
Organization
Contact information
Practice address
2001 SANTA MONICA BLVD, SUITE 360W, SANTA MONICA, CA 90404-2102
(310) 453-1871
(310) 453-3910
Mailing address
2001 SANTA MONICA BLVD, SUITE 360W, SANTA MONICA, CA 90404-2102
(310) 453-1871
(310) 453-3910
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G69602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G696020
—
CA
01
—
W19685
MEDICARE
CA
Enumeration date
08/30/2006
Last updated
11/30/2007
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