Provider Demographics
NPI:1750566956
Name:WOODBURN, MARK ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ABRAHAM
Last Name:WOODBURN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:412-369-9550
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:1140 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2160
Practice Address - Country:US
Practice Address - Phone:412-364-4402
Practice Address - Fax:412-364-3850
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2023-02-02
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Provider Licenses
StateLicense IDTaxonomies
PAMD436061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102418401-0003Medicaid
PA102418401-0004Medicaid