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General NPI Number Information
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NPI Number | 1861431975
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Entity Type | Individual
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Provider Name | JONATHAN WOODSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10 GOVE ST
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City | EAST BOSTON
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State | MA
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Zip | 02128-1920
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Country | US
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Telephone | 617-569-5800
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Fax | 617-568-4780
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Provider Business Mailing Address
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Address Line | 10 GOVE ST
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City | EAST BOSTON
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State | MA
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Zip | 02128-1920
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Country | US
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Telephone | 617-569-5800
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Fax | 617-568-4780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 48097
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License Number State | MA
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