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General NPI Number Information
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NPI Number | 1396005310
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Entity Type | Individual
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Provider Name | JEFFREY MICHAEL KOWALESKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 940 BELMONT ST
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone | 774-826-1860
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Fax |
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Provider Business Mailing Address
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Address Line | VA BOSTON HEALTHCARE 940 BELMONT ST
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 774-826-1860
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | MD459066
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 63698-20
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License Number State | WI
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