Provider Demographics
NPI:1154417095
Name:WOODBRIDGE, MICHAEL VINCENT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VINCENT
Last Name:WOODBRIDGE
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 1:11618 US HWY 70-W
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-550-6133
Mailing Address - Fax:919-550-1802
Practice Address - Street 1:11618 US HWY 70-W
Practice Address - Street 2:SUITE 200-A
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-550-6133
Practice Address - Fax:919-550-1802
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891207EMedicaid
NC2275369AMedicare PIN
NCG27322Medicare UPIN