Individual
AMY R. WOOLDRIDGE
Active
Individual
AMY R. WOOLDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01058321A
IN
207R00000X
Internal Medicine Physician
Primary
01058321A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
01058321A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364755
ANTHEM PIN#
IN
01
—
200311740H,L
MEDICAID GROUP#/LOCATION
—
05
—
200486100
—
IN
01
—
7482613
AETNA PIN#
IN
01
—
900284355
MEDICARE RAILROAD #
IN
Enumeration date
01/19/2006
Last updated
10/11/2010
Update your record
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