Provider Demographics
NPI:1063946721
Name:WOODWARD, SAVANNAH LEE (MD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:LEE
Last Name:WOODWARD
Suffix:
Gender:F
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:I MARINE EXPEDITIONARY FORCE NMRTC CAMP PENDLETON
Mailing Address - Street 2:BOX 555191, ATTN: I MEF CREDENTIALING (RM 4172)
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5191
Mailing Address - Country:US
Mailing Address - Phone:760-719-5100
Mailing Address - Fax:
Practice Address - Street 1:I MARINE EXPEDITIONARY FORCE NMRTC CAMP PENDLETON
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-719-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0464592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN