Provider Demographics
NPI:1316198856
Name:WOODBURY, HOWARD P
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:P
Last Name:WOODBURY
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 1:2500 NEUDORF RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8944
Mailing Address - Country:US
Mailing Address - Phone:336-766-7816
Mailing Address - Fax:336-766-7881
Practice Address - Street 1:2500 NEUDORF RD STE A
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8944
Practice Address - Country:US
Practice Address - Phone:336-766-7816
Practice Address - Fax:336-766-7881
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795189Medicaid
NC7704197Medicaid
NC807510OtherBLUE MEDICARE
NC1028122OtherUNITED HEALTHCARE
046VKOtherBLUE CROSS BLUE SHIELD
NC7704197Medicaid