Provider Demographics
NPI:1609030782
Name:WOITKOWSKI, RAYMOND C (HIS)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:C
Last Name:WOITKOWSKI
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 YVONNE DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226
Mailing Address - Country:US
Mailing Address - Phone:413-442-7284
Mailing Address - Fax:413-442-7284
Practice Address - Street 1:86 YVONNE DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226
Practice Address - Country:US
Practice Address - Phone:413-442-7284
Practice Address - Fax:413-442-7284
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251618237700000X
NY14000008903332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment