Healthcare Provider Details

I. General information

NPI: 1225049661
Provider Name (Legal Business Name): BARBARA T WOJDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 FAIRFAX AVE
LOUISVILLE KY
40207-4905
US

IV. Provider business mailing address

125 FAIRFAX AVE
LOUISVILLE KY
40207-4905
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-6155
  • Fax: 502-895-6156
Mailing address:
  • Phone: 502-895-6155
  • Fax: 502-895-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number29673
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: