MEDICARE: GILLIAN KATZ-WIES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	153636	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M18517	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1023078839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN KATZ-WIES M.D.

Provider Business Mailing Address
First Line	:	93 UNION ST STE 303A
Second Line	:
City	:	NEWTON CENTER
State	:	MA
Zip	:	02459-2241
Country	:	US
Telephone Number	:	617-796-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 UNION ST STE 303A
Second Line	:
City	:	NEWTON CENTER
State	:	MA
Zip	:	02459-2241
Country	:	US
Telephone Number	:	617-796-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	03/09/2017

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