Provider Demographics
NPI:1649277674
Name:KOLODNY, JONATHAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:KOLODNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-762-0425
Mailing Address - Fax:781-762-0634
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-762-0425
Practice Address - Fax:781-762-0634
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA49212207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6198945Medicaid
MAJ04557Medicare ID - Type Unspecified
MA6198945Medicaid