Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35067749 | OH |
N | 207NS0135X | Procedural Dermatology | 35067749 | OH |
NPI | 1013960319 |
---|---|
Provider Name | Dr. Susan G Woods |
First Address | Youngstown, OH 44515-2331 |
Second Address | Youngstown, OH 44515-2331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 17/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0170096 | (05) | OH |
G12213 | (02) |