Provider Demographics
NPI:1316674377
Name:WYCKOFF, MORGAN
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BREWSTER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3693
Mailing Address - Country:US
Mailing Address - Phone:203-993-4361
Mailing Address - Fax:
Practice Address - Street 1:2000 WASHINGTON ST STE 341
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1625
Practice Address - Country:US
Practice Address - Phone:617-964-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant