Healthcare Provider Details

I. General information

NPI: 1780029710
Provider Name (Legal Business Name): VERONICA WALCZAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WASHINGTON ST
TAUNTON MA
02780-2465
US

IV. Provider business mailing address

511 W GROVE ST
MIDDLEBORO MA
02346-1458
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-7293
  • Fax:
Mailing address:
  • Phone: 774-409-2009
  • Fax: 508-386-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA4782
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA4782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: