Provider Demographics
NPI:1528003712
Name:UNDERWOOD, JODY A (MD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:A
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 978 A
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4318
Mailing Address - Fax:401-444-6572
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 948
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-3534
Practice Address - Fax:401-444-3298
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD107002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007009540OtherMEDICARE ID-TYPE UNSPECIFIED
RI15-76362OtherUNITED BEHAVIORAL HEALTH
RI7009540Medicaid
RI26418-3OtherBLUE CROSS
RI409612OtherBLUE CHIP
RI1104801349OtherBUTLER HOSPITAL NPI
RI1528003712OtherNPI
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI
RI0007059356Medicare NSC