Provider Demographics
NPI:1558511998
Name:ANNA WOOTEN MD PC
Entity Type:Organization
Organization Name:ANNA WOOTEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-759-7777
Mailing Address - Street 1:2605 NICHOLSON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8895
Mailing Address - Country:US
Mailing Address - Phone:724-759-7777
Mailing Address - Fax:724-759-7780
Practice Address - Street 1:2605 NICHOLSON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8895
Practice Address - Country:US
Practice Address - Phone:724-759-7777
Practice Address - Fax:724-759-7780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNA WOOTEN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424143208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2054829OtherHIGHMARK BLUE SHIELD
PA114034Medicare PIN