Provider Demographics
NPI:1720061161
Name:MAYNE, JANET ELLEN (DNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELLEN
Last Name:MAYNE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ELLEN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 760
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4260
Mailing Address - Country:US
Mailing Address - Phone:781-756-7273
Mailing Address - Fax:781-721-0725
Practice Address - Street 1:500 SALEM ST
Practice Address - Street 2:WOBURN MEDICAL ASSOCIATES PC
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1200
Practice Address - Country:US
Practice Address - Phone:978-988-9255
Practice Address - Fax:978-694-9675
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0382001Medicaid
NP2369OtherBCBS
NP2369OtherBCBS
MA0382001Medicaid