Healthcare Provider Details

I. General information

NPI: 1821003674
Provider Name (Legal Business Name): SUSAN WOODS MD DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OHLTOWN RD
YOUNGSTOWN OH
44515-2331
US

IV. Provider business mailing address

20 OHLTOWN RD
YOUNGSTOWN OH
44515-2331
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-1557
  • Fax: 330-799-0261
Mailing address:
  • Phone: 330-884-1557
  • Fax: 330-799-0261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35-067749
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35-067749
License Number StateOH

VIII. Authorized Official

Name: DR. SUSAN WOODS
Title or Position: MD/OWNER
Credential: MD
Phone: 330-884-1557