Healthcare Provider Details

I. General information

NPI: 1598323685
Provider Name (Legal Business Name): GREGORY WOODWARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 BALLENGER CENTER DR STE 102
FREDERICK MD
21703-7384
US

IV. Provider business mailing address

1410 SPRING HILL RD STE 305
MC LEAN VA
22102-3020
US

V. Phone/Fax

Practice location:
  • Phone: 301-882-7932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2858
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: