1114925179 NPI number — NORMAN E WOOD JR. DO

Table of content: NORMAN E WOOD JR. DO (NPI 1114925179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114925179 NPI number — NORMAN E WOOD JR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
NORMAN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114925179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20120 BALLINGER WAY NE SUITE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHORELINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-858-5059
Provider Business Mailing Address Fax Number:
949-385-9207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERNPORT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-359-2292
Provider Business Practice Location Address Fax Number:
301-359-2295
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H0056000 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: H005600 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 056200900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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