Provider Demographics
NPI:1396028262
Name:WOODS, MARY VIRGINIA (CPNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA
Last Name:WOODS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD STE 620
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3719
Mailing Address - Country:US
Mailing Address - Phone:215-885-8700
Mailing Address - Fax:215-885-8795
Practice Address - Street 1:261 OLD YORK RD STE 620
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3719
Practice Address - Country:US
Practice Address - Phone:215-885-8700
Practice Address - Fax:215-885-8795
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017207363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics