Provider Demographics
NPI:1013036409
Name:HOOD, MICHAEL S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:HOOD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MECHANIC ST STE 105
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1852
Mailing Address - Country:US
Mailing Address - Phone:732-268-7130
Mailing Address - Fax:
Practice Address - Street 1:65 MECHANIC ST STE 105
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1852
Practice Address - Country:US
Practice Address - Phone:732-268-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002663363A00000X, 363AS0400X
KYPA982363AM0700X
NY016798363AM0700X
NJ25MP00500200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100080480Medicaid
IN300046915Medicaid
OH0068344Medicaid