MEDICARE: DR. ELIZABETH DOROTHY WOODARD M.D.,M.P.H.

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	2083P0901X	Public Health & General Preventive Medicine Physician	104718-1	NY

General Provider Information

NPI Number	:	1215260260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH DOROTHY WOODARD M.D.,M.P.H.

Provider Business Mailing Address
First Line	:	200 RIDGE RD W
Second Line	:	KODAK MEDICAL DEPARTMENT
City	:	ROCHESTER
State	:	NY
Zip	:	14652-3402
Country	:	US
Telephone Number	:	585-722-5703
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RIDGE RD W
Second Line	:	KODAK MEDICAL DEPARTMENT
City	:	ROCHESTER
State	:	NY
Zip	:	14652-3402
Country	:	US
Telephone Number	:	585-722-5703
Fax Number	:

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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