Basic Information
| Provider Information | |||||||||
| NPI: | 1972946960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODSON | ||||||||
| FirstName: | KEVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106014607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146812560 | ||||||||
| FaxNumber: | 9146812590 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 E POST RD | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146812560 | ||||||||
| FaxNumber: | 9146812590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01080128A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 285051 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 285051 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.