Healthcare Provider Details

I. General information

NPI: 1962493817
Provider Name (Legal Business Name): WAYNE TWORETZKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

91 STILES RD
SALEM NH
03079-5804
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6793
  • Fax:
Mailing address:
  • Phone: 603-893-9784
  • Fax: 603-890-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number160107
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: