Provider Demographics
NPI:1386875185
Name:WOODS, THEODORE JR (MD MPH)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:WOODS
Suffix:JR
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SCHOOL STREET
Mailing Address - Street 2:APT. 29
Mailing Address - City:FRISCO CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36445
Mailing Address - Country:US
Mailing Address - Phone:787-414-5411
Mailing Address - Fax:
Practice Address - Street 1:250 W49TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-586-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266543208D00000X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local