Healthcare Provider Details

I. General information

NPI: 1972550341
Provider Name (Legal Business Name): JOHN P. WOODS P.A-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 EASTERN AVE
BALTIMORE MD
21224-2772
US

IV. Provider business mailing address

5000 COX RD STE G1
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 410-814-4500
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax: 410-532-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002802
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: