Provider Demographics
NPI:1932324076
Name:WOODS, THOMAS R (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:WOODS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30915 LORAIN RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4722
Mailing Address - Country:US
Mailing Address - Phone:440-471-4970
Mailing Address - Fax:
Practice Address - Street 1:30915 LORAIN RD
Practice Address - Street 2:SUITE 114
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4722
Practice Address - Country:US
Practice Address - Phone:440-471-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0950636Medicaid
SCPD1279Medicaid
SCU340010281Medicare UPIN
OH0950636Medicaid