Healthcare Provider Details

I. General information

NPI: 1215260260
Provider Name (Legal Business Name): ELIZABETH DOROTHY WOODARD M.D.,M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ELIZABETH DOROTHY VANDERPOOL

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIDGE RD W KODAK MEDICAL DEPARTMENT
ROCHESTER NY
14652-3402
US

IV. Provider business mailing address

200 RIDGE RD W KODAK MEDICAL DEPARTMENT
ROCHESTER NY
14652-3402
US

V. Phone/Fax

Practice location:
  • Phone: 585-722-5703
  • Fax:
Mailing address:
  • Phone: 585-722-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number104718-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: