DR. JACK WITTENBERG MD NPI 1245221894

NPI Information

NPI: 1245221894
Provider Name: DR. JACK WITTENBERG, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
55 FRUIT ST
FND 2
BOSTON, MA
ZIP 02114
Phone: (617) 726-8396
Get Directions

DR. Jack Wittenberg, MD is a diagnostic radiology radiology in Boston, MA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Jack Wittenberg, MD NPI is 1245221894. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

55 FRUIT ST
FND 2
BOSTON, MA
ZIP 02114-621
Phone: (617) 726-8396
Fax: (617) 726-4891

The enumeration date for this NPI number is 11/2/2005 and was last updated on 8/30/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	28711	MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	A65829	MEDICARE UPIN
2	725096	OTHER	MASSACHUSETTS	TUFTS HEALTH PLAN
3	M07089	OTHER	MASSACHUSETTS	BCBS MA
4	M07089	MEDICARE ID-TYPE UNSPECIFIED	MASSACHUSETTS
5	0194255	MEDICAID	MASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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