Provider Demographics
NPI:1366560286
Name:WOODS, STACY BIANCA (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:BIANCA
Last Name:WOODS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16220 S FREDERICK AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4020
Mailing Address - Country:US
Mailing Address - Phone:301-840-1077
Mailing Address - Fax:301-948-6199
Practice Address - Street 1:16220 S FREDERICK AVE STE 308
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4020
Practice Address - Country:US
Practice Address - Phone:301-840-1077
Practice Address - Fax:301-948-6199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00535722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2119312OtherMAMSI LIFE AND HEALTH