Provider Demographics
NPI:1134100241
Name:MUDD, CAROLINE B (NP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:B
Last Name:MUDD
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BMCHS PROVIDER ENROLLMENT
Mailing Address - Street 2:960 MASSACHUSETTS AVE FLR 2
Mailing Address - City:BOS
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 223E-GOOD SAMARITAN WOMEN'S HEALTH
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-427-2222
Practice Address - Fax:508-897-4773
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA181344363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0379531Medicaid
MANP3323Medicare ID - Type Unspecified
MA0379531Medicaid