Healthcare Provider Details

I. General information

NPI: 1477694396
Provider Name (Legal Business Name): WOODBURN ENDOSCOPY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN RD SUITE 109
ANNANDALE VA
22003-1229
US

IV. Provider business mailing address

3301 WOODBURN RD SUITE 109
ANNANDALE VA
22003-1229
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-2557
  • Fax:
Mailing address:
  • Phone: 703-752-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. STAFFORD S GOLDSTEIN
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 703-876-0437