Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 0101229777 | VA |
N | 207RP1001X | Pulmonary Disease | 44622 | WI |
NPI | 1033125927 |
---|---|
Provider Name | Gregory J Wcisel |
First Address | Portsmouth, VA 23707-0068 |
Second Address | Virginia Beach, VA 23454-2444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34223300 | (05) | WI |
G90244 | (02) | WI |