Provider Demographics
NPI:1700894482
Name:WISKE, PRESCOTT S (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:PRESCOTT
Middle Name:S
Last Name:WISKE
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEVINE STREET
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2193
Mailing Address - Country:US
Mailing Address - Phone:203-789-2272
Mailing Address - Fax:203-865-8614
Practice Address - Street 1:2 DEVINE STREET
Practice Address - Street 2:SUITE # 1
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2193
Practice Address - Country:US
Practice Address - Phone:203-789-2272
Practice Address - Fax:203-865-8614
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026355207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060019527OtherMEDICARE RAILROAD PIN
CT060001327Medicare PIN
CT060019527OtherMEDICARE RAILROAD PIN
B38272Medicare UPIN
CT060001327Medicare ID - Type Unspecified
CT060001747Medicare PIN