Provider Demographics
NPI:1114925179
Name:WOOD, NORMAN E JR (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:E
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20120 BALLINGER WAY NE SUITE B
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155
Mailing Address - Country:US
Mailing Address - Phone:206-858-5059
Mailing Address - Fax:949-385-9207
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562
Practice Address - Country:US
Practice Address - Phone:301-359-2292
Practice Address - Fax:301-359-2295
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0056000207Q00000X
MDH005600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056200900Medicaid
MD056200900Medicaid
MDH32903Medicare UPIN