Provider Demographics
NPI:1467578864
Name:DOODY, PATRICK JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:DOODY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381970
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-1970
Mailing Address - Country:US
Mailing Address - Phone:617-441-0101
Mailing Address - Fax:617-441-0100
Practice Address - Street 1:122 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5715
Practice Address - Country:US
Practice Address - Phone:617-441-0101
Practice Address - Fax:617-441-0100
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1607201Medicaid
MAY45711Medicare ID - Type Unspecified
MAU99964Medicare UPIN