Provider Demographics
NPI: | 1730676164 |
---|---|
Name: | WOODS, KATHLEEN ELIZABETH (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | KATHLEEN |
Middle Name: | ELIZABETH |
Last Name: | WOODS |
Suffix: | |
Gender: | F |
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: | 500 UNIVERSITY DR |
Mailing Address - Street 2: | MAIL CODE CA410 |
Mailing Address - City: | HERSHEY |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17033-3070 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-531-5208 |
Mailing Address - Fax: | 717-531-0119 |
Practice Address - Street 1: | 3025 MARKET ST |
Practice Address - Street 2: | ENTRANCE B |
Practice Address - City: | CAMP HILL |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17011-4518 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-691-1212 |
Practice Address - Fax: | 717-691-5354 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-04-20 |
Last Update Date: | 2023-03-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 83479 | 207QA0505X |
390200000X | ||
PA | OS020392 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |