Provider Demographics
NPI:1356433585
Name:WOODRUFF, MARYA (MHS PAC)
Entity type:Individual
Prefix:MS
First Name:MARYA
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:MHS PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT STREET
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-237-3500
Mailing Address - Fax:781-237-7867
Practice Address - Street 1:65 WALNUT STREET
Practice Address - Street 2:SUITE 520
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-237-3500
Practice Address - Fax:781-237-7867
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2027363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP2501Medicare ID - Type Unspecified
P16205Medicare UPIN