Healthcare Provider Details

I. General information

NPI: 1144495011
Provider Name (Legal Business Name): THOMAS L WADZINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 MEMORIAL DR STE 2
CHICOPEE MA
01020-3978
US

IV. Provider business mailing address

1176 MEMORIAL DR STE 2
CHICOPEE MA
01020-3978
US

V. Phone/Fax

Practice location:
  • Phone: 413-593-1333
  • Fax: 413-593-1444
Mailing address:
  • Phone: 413-593-1333
  • Fax: 413-593-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247603
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: