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1174528558

NPI Code Detail

MEDICARE: ALFRED HERMAN WOODWORTH MD

MEDICARE: ALFRED HERMAN WOODWORTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	17535	NC
2	208D00000X	General Practice Physician	17535	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	930040271	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-28863	OTHER	NC	UNITED HEALTHCARE
2	89442	OTHER	NC	BCBS
3	B4563	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1174528558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED HERMAN WOODWORTH MD

Provider Business Mailing Address
First Line	:	4402 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6161
Country	:	US
Telephone Number	:	910-452-1400
Fax Number	:	910-332-1072

Provider Business Practice Location Address
First Line	:	4402 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6161
Country	:	US
Telephone Number	:	910-452-1400
Fax Number	:	910-332-1072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/16/2009

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1508861998 — MATTHEW CHET RADACK MD
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Directions to “ ALFRED HERMAN WOODWORTH MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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