Basic Information
| Provider Information | |||||||||
| NPI: | 1588781660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 ALLEN ST | ||||||||
| Address2: | STE 403 | ||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027724414 | ||||||||
| FaxNumber: | 8027727973 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GENERAL WING RD | ||||||||
| Address2: | |||||||||
| City: | RUTLAND | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057014681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027739131 | ||||||||
| FaxNumber: | 8027756141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 07/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0420010272 | VT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 263700 | 01 | MVP-MOHAWK VALLEY HP | OTHER | 2154018-001 | 01 | CIGNA | OTHER | 1008015 | 05 | VT | MEDICAID | 58194 | 01 | VT | VT BLUE CROSS BLUE SHIELD | OTHER | 286237 | 01 | NH | CIGNA NH | OTHER | 10055973 | 01 | CDPHP | OTHER | 02169184 | 05 | NY | MEDICAID |