Healthcare Provider Details

I. General information

NPI: 1467006627
Provider Name (Legal Business Name): JOHN WOODALL, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 BERKSHIRE RD
SANDY HOOK CT
06482-1361
US

IV. Provider business mailing address

49 DEER HILL AVE
DANBURY CT
06810-7902
US

V. Phone/Fax

Practice location:
  • Phone: 203-491-2577
  • Fax:
Mailing address:
  • Phone: 978-549-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P WOODALL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 978-549-1756