1639108160 NPI number — JOANNE N WOOD MD

Table of content: JOANNE N WOOD MD (NPI 1639108160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639108160 NPI number — JOANNE N WOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
JOANNE
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1639108160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E PENN SQ
Provider Second Line Business Mailing Address:
9TH FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9258
Provider Business Mailing Address Fax Number:
267-425-9299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF PHILA - GENERAL PEDIATRICS
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-2164
Provider Business Practice Location Address Fax Number:
215-590-2180
Provider Enumeration Date:
06/30/2006

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: 208000000X , with the licence number:  MD424559 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: MD424559 , 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: 1013724240002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0072265 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".