Provider Demographics
NPI:1477694396
Name:WOODBURN ENDOSCOPY CENTER, PLLC
Entity Type:Organization
Organization Name:WOODBURN ENDOSCOPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:703-876-0437
Mailing Address - Street 1:3301 WOODBURN RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-752-2557
Mailing Address - Fax:
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-752-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE70218Medicare UPIN
VAC62789Medicare UPIN
VAF36436Medicare UPIN
VAB92750Medicare UPIN
VAB09574Medicare UPIN