Provider Demographics
NPI:1912965062
Name:WOODCOCK, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:WOODCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-272-5052
Mailing Address - Fax:502-629-6217
Practice Address - Street 1:315 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-629-2500
Practice Address - Fax:502-629-2055
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20737207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY110089689OtherRAILROAD MEDICARE
KY1050395OtherPASSPORT PROVIDER NUMB
KY64207376Medicaid
KY000000044802OtherANTHEM PROVIDER NUMB
KY4012991OtherANTHEM PROVIDER NUMB
KY458311OtherCIGNA PROVIDER NUMB
KY000020583AOtherHUMANA PROVIDER NUMB
IN200042670Medicaid
KY458311OtherCIGNA PROVIDER NUMB
KY4012991OtherANTHEM PROVIDER NUMB
IN200042670Medicaid
KY0299001Medicare PIN