Provider Demographics
NPI:1831213727
Name:WOOTEN, ANNA IVANOVNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:IVANOVNA
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2605 NICHOLSON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8896
Mailing Address - Country:US
Mailing Address - Phone:724-759-7777
Mailing Address - Fax:724-759-7780
Practice Address - Street 1:2605 NICHOLSON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8896
Practice Address - Country:US
Practice Address - Phone:724-759-7777
Practice Address - Fax:724-759-7780
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2011-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD424143208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery