1083938278 NPI number — DR NORMAN E WOOD JR PA

Table of content: (NPI 1083938278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083938278 NPI number — DR NORMAN E WOOD JR PA

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1083938278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24441 GARRETT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC HENRY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21541-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-387-7777
Provider Business Mailing Address Fax Number:
301-387-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HC 61 BOX 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPON BRIDGE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26711-9728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-856-2600
Provider Business Practice Location Address Fax Number:
304-856-2604
Provider Enumeration Date:
03/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
THRASHER
Authorized Official First Name:
SUSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
301-387-7777

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  1680 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810004552 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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