Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 223722 | MA |
Y | 111NI0900X | Internist | 223722 | MA |
N | 208000000X | Pediatrician | 223722 | MA |
NPI | 1003806902 |
---|---|
Provider Name | Adam Gregory Wychowski |
First Address | Springfield, MA 01107-1084 |
Second Address | Springfield, MA 01107-1192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 20/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2105276 | (05) | MA |
36483 | HEALTH NEW ENGLAND (01) | MA |
470306 | TUFTS HEALTH PLAN (01) | MA |
I35903 | (02) | |
J28919 | BLUE CROSS BLUE SHIELD MA (01) | MA |