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General NPI Number Information
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NPI Number | 1205845799
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Entity Type | Individual
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Provider Name | STANLEY J. WISNIEWSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 8191 JENNIFER LN 150
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City | OWINGS
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State | MD
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Zip | 20736-3194
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Country | US
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Telephone | 443-964-5159
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Fax | 443-964-5149
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Provider Business Mailing Address
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Address Line | 3691 CHANEYVILLE RD
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City | OWINGS
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State | MD
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Zip | 20736-9134
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Country | US
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Telephone | 410-257-0215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0062090
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License Number State | MD
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