Healthcare Provider Details

I. General information

NPI: 1033285853
Provider Name (Legal Business Name): JAMES M WOODWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

900 N STUART ST 1617
ARLINGTON VA
22203-4101
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4611
  • Fax:
Mailing address:
  • Phone: 703-340-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD050253L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: