Healthcare Provider Details

I. General information

NPI: 1174960652
Provider Name (Legal Business Name): MATHEW D WOODLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6139
  • Fax: 814-877-6093
Mailing address:
  • Phone: 484-628-1324
  • Fax: 814-877-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS017292
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: