Provider Demographics
NPI:1700937570
Name:WOOLLEY, PAUL O JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:O
Last Name:WOOLLEY
Suffix:JR
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 1:3631 PENNS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875
Mailing Address - Country:US
Mailing Address - Phone:814-422-8873
Mailing Address - Fax:814-422-8037
Practice Address - Street 1:3631 PENNS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SPRING MILLS
Practice Address - State:PA
Practice Address - Zip Code:16875
Practice Address - Country:US
Practice Address - Phone:814-422-8873
Practice Address - Fax:814-422-8037
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018941E207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine