DR. JACK WITTENBERG MD NPI 1245221894

NPI Information

  • NPI: 1245221894
  • Provider Name: DR. JACK WITTENBERG, MD
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • Address: 55 FRUIT ST
    FND 2
    BOSTON, MA
    ZIP 02114
  • Phone: (617) 726-8396

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NPI Details

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
12085R0202XRadiologyDiagnostic Radiology28711MASSACHUSETTSYes

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
1A65829MEDICARE UPIN
2725096OTHERMASSACHUSETTSTUFTS HEALTH PLAN
3M07089OTHERMASSACHUSETTSBCBS MA
4M07089MEDICARE ID-TYPE UNSPECIFIEDMASSACHUSETTS
50194255MEDICAIDMASSACHUSETTS

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: 3/30/2025

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