Provider Demographics
NPI:1740458397
Name:WOODARD, TROY DONOVAN (MD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:DONOVAN
Last Name:WOODARD
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 1:9500 EUCLID AVE
Mailing Address - Street 2:A-71
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-445-7157
Mailing Address - Fax:216-445-9409
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:A-71
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-445-7157
Practice Address - Fax:216-445-9409
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060486207Y00000X
OH35.093756207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2965313Medicaid