Provider Demographics
NPI:1407659493
Name:WOODS-SAM, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WOODS-SAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SHINING WILLOW WAY STE 20034
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4224
Mailing Address - Country:US
Mailing Address - Phone:301-242-3229
Mailing Address - Fax:202-217-4225
Practice Address - Street 1:6778 LANTANA DR
Practice Address - Street 2:
Practice Address - City:BRYANS ROAD
Practice Address - State:MD
Practice Address - Zip Code:20616-4227
Practice Address - Country:US
Practice Address - Phone:301-242-3229
Practice Address - Fax:202-217-4225
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD33-215382171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator