Healthcare Provider Details

I. General information

NPI: 1639177496
Provider Name (Legal Business Name): MARC P WLADIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date: 03/17/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

1 WASHINGTON ST
TAUNTON MA
02780-5293
US

IV. Provider business mailing address

4 FURLONG CIR
LAKEVILLE MA
02347-2144
US

V. Phone/Fax

Practice location:
  • Phone: 508-802-6770
  • Fax: 508-802-6775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number48096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: