Healthcare Provider Details

I. General information

NPI: 1962078675
Provider Name (Legal Business Name): THAINE ROBERT WESTBROOK WOODROW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 DOCTORS LN STE 202
CLARION PA
16214-8574
US

IV. Provider business mailing address

24 DOCTORS LN STE 202
CLARION PA
16214-8574
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-2500
  • Fax: 814-226-4505
Mailing address:
  • Phone: 814-226-2500
  • Fax: 814-226-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number329657
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT020590
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: