1366586497 NPI number — DR. JOSEPH RICHARD WOODLEY OD

Table of content: DR. JOSEPH RICHARD WOODLEY OD (NPI 1366586497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366586497 NPI number — DR. JOSEPH RICHARD WOODLEY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODLEY
Provider First Name:
JOSEPH
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1366586497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 BRADFORD SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAFFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15085-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-860-9874
Provider Business Mailing Address Fax Number:
814-443-0590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 REVCO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-7726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-860-9874
Provider Business Practice Location Address Fax Number:
814-443-0590
Provider Enumeration Date:
02/20/2007

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: 152WC0802X , with the licence number:  OEG000197 , 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: 01887557 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6175207 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 051407 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1349779 . This is a "PA BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 311352 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1531122 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410047141 . This is a "PA RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: U87145 . This is a "HEALTH AMERICA ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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