Provider Demographics
NPI:1568843084
Name:WOODWARD, KRISTEN (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RICHMOND ROAD
Mailing Address - Street 2:EDGEWOOD PEDIATRICS
Mailing Address - City:HAMILTON
Mailing Address - State:HAMILTON
Mailing Address - Zip Code:HM08
Mailing Address - Country:BM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 RICHMOND ROAD
Practice Address - Street 2:C/O EDGEWOOD PEDIATRICS
Practice Address - City:HAMILTON
Practice Address - State:HAMILTON
Practice Address - Zip Code:HM08
Practice Address - Country:BM
Practice Address - Phone:441-295-8000
Practice Address - Fax:441-236-8338
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP03531208000000X
MA274253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty