MEDICARE: WILLIAM H SOUTHWICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	208346	MA

General Provider Information

NPI Number	:	1780621318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM H SOUTHWICK M.D.

Provider Business Mailing Address
First Line	:	256 BUNN DR
Second Line	:	SUITE #6
City	:	PRINCETON
State	:	NJ
Zip	:	08540-2859
Country	:	US
Telephone Number	:	617-325-1230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 CENTRE ST
Second Line	:	DEUTSCHES ALTENHEIM GERMAN CTR
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-4034
Country	:	US
Telephone Number	:	617-325-1230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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