Healthcare Provider Details

I. General information

NPI: 1700937570
Provider Name (Legal Business Name): PAUL O WOOLLEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 PENNS VALLEY RD
SPRING MILLS PA
16875
US

IV. Provider business mailing address

3631 PENNS VALLEY RD
SPRING MILLS PA
16875
US

V. Phone/Fax

Practice location:
  • Phone: 814-422-8873
  • Fax: 814-422-8037
Mailing address:
  • Phone: 814-422-8873
  • Fax: 814-422-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD018941E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD018941E
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: