Individual
DAVID M WODICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2019 TATE SPRINGS RD, LYNCHBURG, VA 24501-1111
(434) 846-7374
(434) 846-1910
Mailing address
2019 TATE SPRINGS RD, LYNCHBURG, VA 24501-1111
(434) 846-7374
(434) 846-1910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101036506
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005601622
—
VA
01
—
065993
ANTHEM
—
01
—
080027740
MEDICARE RAILROAD PROVIDER NUMBER
—
Enumeration date
11/22/2005
Last updated
08/13/2013
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