Provider Demographics
NPI:1861662868
Name:EARLE G. WOODMAN, M.D.,P.C.
Entity type:Organization
Organization Name:EARLE G. WOODMAN, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-453-3069
Mailing Address - Street 1:148 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2505
Mailing Address - Country:US
Mailing Address - Phone:781-453-3069
Mailing Address - Fax:781-453-3660
Practice Address - Street 1:148 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2505
Practice Address - Country:US
Practice Address - Phone:781-453-3069
Practice Address - Fax:781-453-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26212207QA0505X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16037OtherBLUE CROSS/BLUE SHIELD
66308OtherHARVARD PILGRIM
M18953OtherBLUE CROSS/BLUE SHIELD
026212OtherTUFTS
MA9750011Medicaid
MA9750011Medicaid
C16037OtherBLUE CROSS/BLUE SHIELD