Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 14482 | NH |
N | 208200000X | Surgeon | 224790 | MA |
N | 208600000X | Surgeon | 224790 | MA |
Y | 208800000X | Urologist | 14482 | NH |
NPI | 1003884578 |
---|---|
Provider Name | Chad Wotkowicz |
First Address | Dover, NH 03820-2892 |
Second Address | Dover, NH 03820-2892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 10/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2111021 | (05) | MA |
30209883 | (05) | NH |
I44049 | (02) | MA |