Provider Demographics
NPI:1104007426
Name:WOODBURY FAMILY PRACTICE
Entity Type:Organization
Organization Name:WOODBURY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-430-2935
Mailing Address - Street 1:7 MILL ROAD PLZ # C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3047
Mailing Address - Country:US
Mailing Address - Phone:603-430-0060
Mailing Address - Fax:603-570-2036
Practice Address - Street 1:7 MILL RD UNIT C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3047
Practice Address - Country:US
Practice Address - Phone:603-430-0060
Practice Address - Fax:603-570-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty