Provider Demographics
NPI:1063454775
Name:W M WOODWARD, MD, PA
Entity Type:Organization
Organization Name:W M WOODWARD, MD, PA
Other - Org Name:CHARLESTON PAIN & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BUNCHER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-556-3462
Mailing Address - Street 1:1124 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3362
Mailing Address - Country:US
Mailing Address - Phone:843-556-3462
Mailing Address - Fax:843-766-2103
Practice Address - Street 1:1124 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3362
Practice Address - Country:US
Practice Address - Phone:843-556-3462
Practice Address - Fax:843-766-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1103Medicaid
SC6423830001Medicare NSC
SC1641Medicare PIN
SCGP1103Medicaid