Provider Demographics
NPI:1508825423
Name:WOODWARD, MARTIN BRYAN III (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BRYAN
Last Name:WOODWARD
Suffix:III
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:6115 PARK SOUTH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3269
Mailing Address - Country:US
Mailing Address - Phone:704-554-8787
Mailing Address - Fax:704-554-8774
Practice Address - Street 1:6115 PARK SOUTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3269
Practice Address - Country:US
Practice Address - Phone:704-554-8787
Practice Address - Fax:704-554-8774
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9500277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2331258Medicare ID - Type Unspecified
NCC78801Medicare UPIN