Basic Information
| Provider Information | |||||||||
| NPI: | 1134238405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4536 BONNEY RD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234623869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574909388 | ||||||||
| FaxNumber: | 7574909401 | ||||||||
| Practice Location | |||||||||
| Address1: | 736 BATTLEFIELD BLVD N | ||||||||
| Address2: | CHESAPEAKE GENERAL HOSPITAL | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573126200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 0101053151 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 3900570 | 01 | OPTIMUM CHOICE | OTHER | 082480 | 01 | VA | BLUE CROSS BLUE SHIELD VA | OTHER | 5847320 | 05 | VA | MEDICAID | 063YM | 01 | NC | BLUE CROSS BLUE SHIELD NC | OTHER | 930088666 | 01 | MEDICARE RAILROAD | OTHER | 251490 | 01 | MAMSI/MDIPA | OTHER | 27949 | 01 | OPTIMA | OTHER | 89063YM | 05 | NC | MEDICAID |