Provider Demographics
NPI:1154320133
Name:WOOD, DAVID EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:WOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 DUTCH LN
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3010
Mailing Address - Country:US
Mailing Address - Phone:724-962-3210
Mailing Address - Fax:724-962-9034
Practice Address - Street 1:1623 DUTCH LN
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3010
Practice Address - Country:US
Practice Address - Phone:724-962-3210
Practice Address - Fax:724-962-9034
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-05-04
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PAOS009031L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015759250007Medicaid
PA852315OtherHIGHMARK BS PA
PA62580OtherMEDPLUS
PA1035584OtherGATEWAY
PA852315Medicare PIN
PA62580OtherMEDPLUS