Healthcare Provider Details

I. General information

NPI: 1275110009
Provider Name (Legal Business Name): KERRY WOODS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9841 BROKEN LAND PKWY STE 211
COLUMBIA MD
21046-3068
US

IV. Provider business mailing address

9841 BROKEN LAND PKWY STE 211
COLUMBIA MD
21046-3068
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-5856
  • Fax:
Mailing address:
  • Phone: 443-708-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberH0107344
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: