Provider Demographics
NPI:1124024245
Name:WOODCOME, HAROLD ARTHUR JR (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ARTHUR
Last Name:WOODCOME
Suffix:JR
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 1:101 PLAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4828
Mailing Address - Country:US
Mailing Address - Phone:401-274-5844
Mailing Address - Fax:401-274-9462
Practice Address - Street 1:101 PLAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4828
Practice Address - Country:US
Practice Address - Phone:401-274-5844
Practice Address - Fax:401-274-9462
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD4854207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6147518Medicaid
RI7000374Medicaid
RI007000374Medicare ID - Type Unspecified
MA6147518Medicaid
MAA21566Medicare ID - Type Unspecified