Provider Demographics
NPI:1467472399
Name:JANICE CLEVELAND WASHBURN, MD, PC
Entity Type:Organization
Organization Name:JANICE CLEVELAND WASHBURN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-235-1533
Mailing Address - Street 1:386 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6213
Mailing Address - Country:US
Mailing Address - Phone:781-235-1533
Mailing Address - Fax:781-235-1156
Practice Address - Street 1:386 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6213
Practice Address - Country:US
Practice Address - Phone:781-235-1533
Practice Address - Fax:781-235-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76066207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18998OtherBLUE CROSS GROUP NUMBER
MA4252491OtherAETNA PROVIDER #
MA77861OtherHCVM/CCN
MA076066OtherTUFTS PROVIDER NUMBER
MA401030NEMCOtherHARVARD PILGRIM PROVIDER
MA77861OtherHCVM/CCN
MAM18998OtherBLUE CROSS GROUP NUMBER