Provider Demographics
NPI:1790784742
Name:PAUL V WOOLLEY, MD, PC
Entity Type:Organization
Organization Name:PAUL V WOOLLEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-536-7510
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15907-0488
Mailing Address - Country:US
Mailing Address - Phone:814-536-7510
Mailing Address - Fax:814-536-7527
Practice Address - Street 1:88 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4146
Practice Address - Country:US
Practice Address - Phone:814-536-7510
Practice Address - Fax:814-536-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046527L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1510090OtherHIGHMARK BLUE CROSS
PA1008421970001Medicaid
PA1008421970001Medicaid