Basic Information
Provider Information
NPI: 1801098439
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOODS
FirstName: ASHANTI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherLastNameType:  
Mailing Information
Address1: 301 ST. PAUL PLACE
Address2: MEDICAL STAFF OFFICE
City: BALTIMORE
State: MD
PostalCode: 212022102
CountryCode: US
TelephoneNumber: 4106592802
FaxNumber:  
Practice Location
Address1: 301 ST. PAUL PLACE
Address2: 12TH FLOOR, TOWER
City: BALTIMORE
State: MD
PostalCode: 21202
CountryCode: US
TelephoneNumber: 4105005500
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 06/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XD71714MDY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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