Provider Demographics
NPI:1558340042
Name:WOODS, SAMUEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:WOODS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:WODNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:607 IDOL ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7804
Mailing Address - Country:US
Mailing Address - Phone:336-802-2000
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:SUITE 200 D
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-802-2075
Practice Address - Fax:336-802-2076
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-048623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5855420Medicaid
NC8989146Medicaid
A61166Medicare UPIN
110008032Medicare ID - Type Unspecified
VA5855420Medicaid
NC2142829BMedicare PIN