Healthcare Provider Details

I. General information

NPI: 1760820591
Provider Name (Legal Business Name): COLIN MATTHEW WOODARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE STE 201
CRANSTON RI
02920-6092
US

IV. Provider business mailing address

PO BOX 202230
DALLAS TX
75320-2230
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-1300
  • Fax: 401-946-8480
Mailing address:
  • Phone: 401-943-1300
  • Fax: 401-946-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDO00958
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: