Healthcare Provider Details

I. General information

NPI: 1194316638
Provider Name (Legal Business Name): WARD FICKWEILER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL
BOSTON MA
02215-5306
US

IV. Provider business mailing address

16 HOLDEN ST
CAMBRIDGE MA
02138-2022
US

V. Phone/Fax

Practice location:
  • Phone: 857-285-1561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00000000
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: