Provider Demographics
NPI:1083688337
Name:WOOD, DIANE D (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4200 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-9668
Mailing Address - Country:US
Mailing Address - Phone:570-644-2042
Mailing Address - Fax:570-644-4582
Practice Address - Street 1:4200 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-9668
Practice Address - Country:US
Practice Address - Phone:570-644-2042
Practice Address - Fax:570-644-4582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA000661L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical