Provider Demographics
NPI:1912946260
Name:WOODBURY, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 FAYETTE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1797
Mailing Address - Country:US
Mailing Address - Phone:610-828-8500
Mailing Address - Fax:610-828-9736
Practice Address - Street 1:612 FAYETTE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1797
Practice Address - Country:US
Practice Address - Phone:610-828-8500
Practice Address - Fax:610-828-9736
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056674L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015954810004Medicaid
PA0585148OtherAETNA HMO
PA223718OtherALLIANCE/OPT CHC (MAMSI)
PA5852947OtherCIGNA HMO/PPO
PA967674OtherPHCS
PA0128798000OtherIBC - PC/KHPE
PA0128798000OtherAMERIHEALTH/INTERCOUNTY
PA080085941OtherRRM
PA10939019OtherCAQH ID#
PA17213-MD056674LOtherHEALTH PARTNERS
PA5506461OtherAETNA PPO
PA0159548101OtherAMERICHOICE (UHC MA PLAN)
PAP1293177OtherOXFORD
PA1076963OtherKEYSTONE MERCY
PA891990OtherHIGHMARK BLUE SHIELD
PA17213-MD056674LOtherHEALTH PARTNERS
PA5852947OtherCIGNA HMO/PPO