Provider Demographics
NPI:1982700688
Name:WOODS, MICHAEL AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AUSTIN
Last Name:WOODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:978-927-1919
Mailing Address - Fax:978-927-5206
Practice Address - Street 1:5 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-5504
Practice Address - Country:US
Practice Address - Phone:978-774-0730
Practice Address - Fax:978-750-0246
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58712208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3029697Medicaid
MAJ07008Medicare PIN
MA3029697Medicaid