Basic Information
| Provider Information | |||||||||
| NPI: | 1922014778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR NORMAN E WOOD INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | DOCTORS URGENT CARE AND FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 206 | ||||||||
| Address2: | 90 MAIN ST. | ||||||||
| City: | WESTERNPORT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013592295 | ||||||||
| FaxNumber: | 3013592295 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | WESTERNPORT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013592292 | ||||||||
| FaxNumber: | 3013592295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3013592292 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H0056000 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261Q00000X | 1680 | WV | N | Ambulatory Health Care Facilities | Clinic/Center | 208000000X | H5600 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | H56000 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 056200900 | 05 | MD | MEDICAID |