Provider Demographics
NPI:1679546014
Name:WOODDELL, WILLIAM SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:WOODDELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 BATTLEFIELD BLVD N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4516
Mailing Address - Country:US
Mailing Address - Phone:757-436-5824
Mailing Address - Fax:757-548-4048
Practice Address - Street 1:300 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4516
Practice Address - Country:US
Practice Address - Phone:757-436-5824
Practice Address - Fax:757-548-4048
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000785213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9330445Medicaid
VA480000568Medicare Oscar/Certification
VAT87774Medicare UPIN