Provider Demographics
NPI:1417936238
Name:WOODS, LARRY A (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:WOODS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 AVALON DR SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2180
Mailing Address - Country:US
Mailing Address - Phone:330-727-3755
Mailing Address - Fax:
Practice Address - Street 1:8600 E MARKET ST STE 8
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2375
Practice Address - Country:US
Practice Address - Phone:330-469-9035
Practice Address - Fax:330-288-0586
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2495-W207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0514698Medicaid
OH060003079OtherRAILROAD MEDICARE
OH0514698Medicaid