Healthcare Provider Details

I. General information

NPI: 1619950045
Provider Name (Legal Business Name): JOHN W. WINKELMAN PHD/MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

12 FIELD RD
LEXINGTON MA
02421-8015
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-7426
  • Fax:
Mailing address:
  • Phone: 781-929-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number73677
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73677
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number73677
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: