Provider Demographics
NPI:1447202395
Name:WOOD, DAVID A (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:143 N RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1330
Mailing Address - Country:US
Mailing Address - Phone:570-645-1540
Mailing Address - Fax:570-645-1931
Practice Address - Street 1:143 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1330
Practice Address - Country:US
Practice Address - Phone:570-645-1540
Practice Address - Fax:570-645-1931
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009605L207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001957080Medicaid
PA0019570800005Medicaid
PA001957080Medicaid
H89292Medicare UPIN