MEDICARE: DR. JUSTIN WOODHOUSE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	35084837	OH
2	207N00000X	Dermatology Physician	35084837	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9186059	OTHER	OH	MEDICARE GROUP LEGACY
2	9186053	OTHER	OH	MEDICARE GROUP LEGACY
5	9186052	OTHER	OH	MEDICARE GROUP LEGACY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1154487932	OTHER	OH	GROUP NPI

General Provider Information

NPI Number	:	1225128556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN WOODHOUSE MD

Provider Business Mailing Address
First Line	:	3624 W MARKET ST STE 101
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4510
Country	:	US
Telephone Number	:	330-665-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 LANDERBROOK DR
Second Line	:	SUITE 120
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4039
Country	:	US
Telephone Number	:	216-382-3806
Fax Number	:	216-382-6735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/17/2025

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Directions to “ DR. JUSTIN WOODHOUSE MD” Practice Location

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