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Provider Information for 1104873785

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

TETIANA M PRONCHICK M.D.

Gender: FEMALE

Individual NPI: 1104873785

Calendar   Last Updated:  2013-05-21
  Certification Date: 

Details

Name Value
NPI 1104873785
Enumeration Date 2006-05-28
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2000 WASHINGTON ST SUITE 466
NEWTON, MA 02462-1650
United States

Phone: 617-969-8989 | Fax: 617-928-0178
View Map External Link
Primary Practice Address 2000 WASHINGTON ST SUITE 466
NEWTON, MA 02462-1650
United States

Phone: 617-969-8989 | Fax: 617-928-0178
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 208000000X - Pediatrics MA 206084