1912946260 NPI number — DEBORAH WOODBURY MD

Table of content: DEBORAH WOODBURY MD (NPI 1912946260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912946260 NPI number — DEBORAH WOODBURY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODBURY
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912946260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 FAYETTE ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-1797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-828-8500
Provider Business Mailing Address Fax Number:
610-828-9736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 FAYETTE ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
CONSHOHOCKEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19428-1797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-828-8500
Provider Business Practice Location Address Fax Number:
610-828-9736
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD056674L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0015954810004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585148 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 223718 . This is a "ALLIANCE/OPT CHC (MAMSI)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5852947 . This is a "CIGNA HMO/PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 967674 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0128798000 . This is a "IBC - PC/KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0128798000 . This is a "AMERIHEALTH/INTERCOUNTY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080085941 . This is a "RRM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 10939019 . This is a "CAQH ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 17213-MD056674L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5506461 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0159548101 . This is a "AMERICHOICE (UHC MA PLAN)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P1293177 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1076963 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 891990 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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