Provider Demographics
NPI:1386266773
Name:KING-WOODWARD, DEIDRE CHERYL
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:CHERYL
Last Name:KING-WOODWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 FLAGSTONE ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4655
Mailing Address - Country:US
Mailing Address - Phone:301-613-8594
Mailing Address - Fax:
Practice Address - Street 1:3487 FLAGSTONE ST
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-4655
Practice Address - Country:US
Practice Address - Phone:301-613-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care