Basic Information
Provider Information
NPI: 1710963624
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOODARD
FirstName: WILLIAM
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5655 HUDSON DR STE 210
Address2: ARIS RADIOLOGY
City: HUDSON
State: OH
PostalCode: 442364455
CountryCode: US
TelephoneNumber: 3306551869
FaxNumber: 3306553828
Practice Location
Address1: 43 LAURENS ST
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294011561
CountryCode: US
TelephoneNumber: 8432761465
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/22/2005
LastUpdateDate: 12/05/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X19237SCY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085N0700X19237SCN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology

No ID Information.


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