Provider Demographics
NPI:1346207842
Name:WOOLVERTON, HUGH III (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:
Last Name:WOOLVERTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:479 SWANSEA MALL DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4119
Practice Address - Country:US
Practice Address - Phone:508-973-1570
Practice Address - Fax:508-973-1545
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA52943207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110064691AMedicaid
MAJ0352301Medicare PIN
MA303523Medicare ID - Type Unspecified
MA6179347Medicaid