Provider Demographics
NPI:1225656598
Name:WOODRUFF, SIDNEY GALE
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:GALE
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 VERMONT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4902
Mailing Address - Country:US
Mailing Address - Phone:844-381-4432
Mailing Address - Fax:
Practice Address - Street 1:3298 FORT LINCOLN DR NE APT 224
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4306
Practice Address - Country:US
Practice Address - Phone:202-830-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant