1417982281 NPI number — BRADFORD J WOOD M.D.

Table of content: BRADFORD J WOOD M.D. (NPI 1417982281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417982281 NPI number — BRADFORD J WOOD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
BRADFORD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1417982281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1358 LUTZTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOILING SPRINGS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17007-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-258-3274
Provider Business Mailing Address Fax Number:
717-258-0311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1358 LUTZTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOILING SPRINGS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17007-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-258-3274
Provider Business Practice Location Address Fax Number:
717-258-0311
Provider Enumeration Date:
07/11/2006

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:  MD024822E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1734461 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WO141016 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0810486 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810559 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01625501 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P003033 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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