Provider Demographics
NPI:1871576645
Name:WOOD, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2338 US RT#5
Mailing Address - Street 2:PO BOX 646
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829-0646
Mailing Address - Country:US
Mailing Address - Phone:802-766-4794
Mailing Address - Fax:802-766-4721
Practice Address - Street 1:2338 US RT#5
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829-0646
Practice Address - Country:US
Practice Address - Phone:802-766-4794
Practice Address - Fax:802-766-4721
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT42-0007829207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009491Medicaid
VT9491Medicare PIN
VTC59332Medicare UPIN