Provider Demographics
NPI:1386769149
Name:DOUGLAS B WOODRUFF MD PA
Entity type:Organization
Organization Name:DOUGLAS B WOODRUFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT FOR DOUGLAS B WOODRUFF MD PA
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-889-5455
Mailing Address - Street 1:4419 FALLS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1226
Mailing Address - Country:US
Mailing Address - Phone:410-889-5455
Mailing Address - Fax:410-366-0651
Practice Address - Street 1:4419 FALLS RD
Practice Address - Street 2:SUITE E
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1226
Practice Address - Country:US
Practice Address - Phone:410-889-5455
Practice Address - Fax:410-366-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD154132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
76842Medicare UPIN