Provider Demographics
NPI:1821097700
Name:WOODWARD, TIPAPORN (MD)
Entity Type:Individual
Prefix:
First Name:TIPAPORN
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIP.
Other - Middle Name:
Other - Last Name:WOODWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-3316
Mailing Address - Fax:301-656-5535
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-3316
Practice Address - Fax:301-656-5535
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9042OtherBLUE CROSS
DC2801OtherBLUE CROSS
MD9042OtherBLUE CROSS
C61759Medicare UPIN