Individual
KEVIN A. WOODWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2905
(443) 444-4731
Mailing address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2905
(443) 444-4731
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C04024
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160704900
—
MD
01
—
LQ23JH
CAREFIRST BC/BS MD
MD
01
—
W616
CAREFIRST BC/BS DC
MD
Enumeration date
08/18/2009
Last updated
08/18/2009
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