Provider Demographics
NPI:1669516068
Name:WOODWARD, ROBERT WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WARREN
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-6103
Mailing Address - Country:US
Mailing Address - Phone:336-349-3982
Mailing Address - Fax:336-349-3982
Practice Address - Street 1:637 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-6103
Practice Address - Country:US
Practice Address - Phone:336-349-3982
Practice Address - Fax:336-349-3982
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989174Medicaid
NCC81394Medicare UPIN
NC8989174Medicaid