Healthcare Provider Details

I. General information

NPI: 1578535753
Provider Name (Legal Business Name): STANISLAWA WEREMOWICZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST ARMORY BLDG 3RD FLOOR 160A
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST ARMORY BLDG 3RD FLOOR 160A
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-7981
  • Fax: 617-975-0945
Mailing address:
  • Phone: 617-732-7981
  • Fax: 617-975-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number93316
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: