Provider Demographics
NPI:1780663237
Name:FOODIM, JOANNE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:FOODIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:MEDICAL HEALTHCARE SOLUTIONS INC
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0803
Mailing Address - Country:US
Mailing Address - Phone:978-474-8885
Mailing Address - Fax:978-474-8845
Practice Address - Street 1:2 CHURCH STREET SOUTH
Practice Address - Street 2:SUITE 408
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-772-4468
Practice Address - Fax:203-772-4033
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2012-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT028143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110007710Medicare ID - Type Unspecified
E28483Medicare UPIN