Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 56321 | MA |
N | 111NI0900X | Internist | 56321 | MA |
Y | 207RH0000X | Hematologist | 56321 | MA |
NPI | 1295726495 |
---|---|
Provider Name | Dr. Walter H Dzik |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 21/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3002446 | (05) | MA |
791725 | TUFTS HEALTH PLAN (01) | MA |
D82910 | (02) | |
J05450 | BCBS MA (01) | MA |