Basic Information
Provider Information
NPI: 1730262510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOOD
FirstName: ROBERT
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.D., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3333 BURNET AVE.
Address2: ML 2021
City: CINCINNATI
State: OH
PostalCode: 452293039
CountryCode: US
TelephoneNumber: 5136366771
FaxNumber: 5136364615
Practice Location
Address1: 3333 BURNET AVE.
Address2: ML 2021
City: CINCINNATI
State: OH
PostalCode: 452293039
CountryCode: US
TelephoneNumber: 5136366771
FaxNumber: 5136364615
Other Information
ProviderEnumerationDate: 10/23/2006
LastUpdateDate: 01/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0214X35.037993OHY Allopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology

No ID Information.


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