1518966464 NPI number — DR. RONALD CLARK WOOD III P.T.

Table of content: DR. RONALD CLARK WOOD III P.T. (NPI 1518966464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518966464 NPI number — DR. RONALD CLARK WOOD III P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
RONALD
Provider Middle Name:
CLARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
P.T.
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:
1518966464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 OFFICE PARK WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14534-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-271-1670
Provider Business Mailing Address Fax Number:
585-271-1675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 OFFICE PARK WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14534-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-271-1670
Provider Business Practice Location Address Fax Number:
585-271-1675
Provider Enumeration Date:
07/21/2005

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: 225100000X , with the licence number:  021702 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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