MEDICARE: DR. JEFFREY S WISCH MD

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	174400000X	Specialist	45726	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871560664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY S WISCH MD

Provider Business Mailing Address
First Line	:	2014 WASHINGTON ST
Second Line	:	VERNON CANCER CENTER
City	:	NEWTON
State	:	MA
Zip	:	02462-1607
Country	:	US
Telephone Number	:	617-658-6000
Fax Number	:	617-658-6001

Provider Business Practice Location Address
First Line	:	2014 WASHINGTON ST
Second Line	:	VERNON CANCER CENTER
City	:	NEWTON
State	:	MA
Zip	:	02462-1607
Country	:	US
Telephone Number	:	617-658-6000
Fax Number	:	617-658-6001

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/05/2009

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