Provider Demographics
NPI:1003233560
Name:ETRA, JOANNA WOLF (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:WOLF
Last Name:ETRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 FRANCIS ST STE 9B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-632-9513
Mailing Address - Fax:
Practice Address - Street 1:110 FRANCIS ST STE 9B
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287050208600000X
CODR.00712692086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery