Provider Demographics
NPI:1720050586
Name:TODD, JAMES WINGATE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WINGATE
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-965-2328
Mailing Address - Fax:617-965-0711
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 403
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-965-2328
Practice Address - Fax:617-965-0711
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA32965207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0171131Medicaid
MAB30125Medicare ID - Type UnspecifiedPHYSICIAN
MA0171131Medicaid