Provider Demographics
NPI:1255514923
Name:DEBORAH S. WOOTEN, M.D., LLC
Entity type:Organization
Organization Name:DEBORAH S. WOOTEN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-659-4084
Mailing Address - Street 1:201 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2211
Mailing Address - Country:US
Mailing Address - Phone:781-659-4084
Mailing Address - Fax:781-659-4065
Practice Address - Street 1:201 RIVER ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2211
Practice Address - Country:US
Practice Address - Phone:781-659-4084
Practice Address - Fax:781-659-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF88134Medicare UPIN