Healthcare Provider Details

I. General information

NPI: 1982665485
Provider Name (Legal Business Name): JONATHAN MICHAEL WINOGRAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN STREET WAC 453
BOSTON MA
02114-3117
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-1915
  • Fax: 617-726-5483
Mailing address:
  • Phone: 617-726-1915
  • Fax: 617-726-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number211623
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number211623
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: