Provider Demographics
NPI:1770673626
Name:WOOLF, ALAN D (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:WOOLF
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3212
Mailing Address - Country:US
Mailing Address - Phone:781-665-0661
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-8177
Practice Address - Fax:617-730-0049
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2071800Medicaid
MA2071800Medicaid
WO B39177Medicare ID - Type Unspecified