Provider Demographics
NPI:1114934619
Name:WOODARD, WARDEN L III (MD)
Entity Type:Individual
Prefix:
First Name:WARDEN
Middle Name:L
Last Name:WOODARD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-446-9046
Mailing Address - Fax:704-446-9066
Practice Address - Street 1:1100 S TRYON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4239
Practice Address - Country:US
Practice Address - Phone:704-446-9046
Practice Address - Fax:704-446-9066
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26905207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88964OtherBCBS
SCN26905Medicaid
NC8988964Medicaid
NC1114934619Medicaid
NC8988964Medicaid
NC211687JMedicare PIN
NCNCF895AMedicare PIN
SCN26905Medicaid
NC211687KMedicare PIN
NC110239665Medicare PIN