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General NPI Number Information
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NPI Number | 1508862509
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Entity Type | Individual
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Provider Name | PHILIP WISOTSKY MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 11350 PEMBROOKE SQ STE 311
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City | WALDORF
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State | MD
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Zip | 20603-4809
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Country | US
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Telephone | 301-870-0660
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Fax | 301-932-8310
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Provider Business Mailing Address
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Address Line | 11350 PEMBROOKE SQ STE 311
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City | WALDORF
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State | MD
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Zip | 20603-4809
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Country | US
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Telephone | 301-870-0660
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Fax | 301-932-8310
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | D18545
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D18545
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License Number State | MD
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