Provider Demographics
NPI:1275265563
Name:WOODCOCK, KEYDER MARTIN
Entity Type:Individual
Prefix:MR
First Name:KEYDER
Middle Name:MARTIN
Last Name:WOODCOCK
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 1:2711 1ST AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1358
Mailing Address - Country:US
Mailing Address - Phone:681-286-6033
Mailing Address - Fax:
Practice Address - Street 1:137 8TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2510
Practice Address - Country:US
Practice Address - Phone:304-747-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23-9211175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist