Provider Demographics
NPI:1912004177
Name:WOODLE, EDWARD M (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:WOODLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 STUTZMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3603
Mailing Address - Country:US
Mailing Address - Phone:724-465-9000
Mailing Address - Fax:724-465-7617
Practice Address - Street 1:660 STUTZMAN RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3603
Practice Address - Country:US
Practice Address - Phone:724-465-9000
Practice Address - Fax:724-465-7617
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007141L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1465395OtherUMWA
PA714382OtherHIGHMARK
PA0012770100007Medicaid
PA080090513Medicare PIN
PA714382OtherHIGHMARK
PA714382Medicare PIN