Provider Demographics
NPI:1972779023
Name:WOODRUFF, DOUGLAS BRIAN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 FALLS ROAD
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:510-366-0651
Practice Address - Street 1:4419 FALLS ROAD
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
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00154132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry