Provider Demographics
NPI:1932267184
Name:WOODWARD, JASON RUSSELL (MS, MPH, RD, LD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RUSSELL
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MS, MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 RIVER BEND CT
Mailing Address - Street 2:APT D202
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724
Mailing Address - Country:US
Mailing Address - Phone:316-214-6195
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:6900 GEORGIA AVE., NW, ATTN MCHL-MAO-C
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06242133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered