Provider Demographics
NPI:1386302651
Name:WOODARD, ADEENA RACHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ADEENA
Middle Name:RACHELLE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S CEDAR CREST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6224
Mailing Address - Country:US
Mailing Address - Phone:610-402-8900
Mailing Address - Fax:610-402-5656
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-8900
Practice Address - Fax:610-402-5656
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005840207XS0106X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOA005840OtherSTATE LICENSE