Provider Demographics
NPI:1235356114
Name:GLENN WOOD MD PA
Entity Type:Organization
Organization Name:GLENN WOOD MD PA
Other - Org Name:CAROUSEL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-448-4433
Mailing Address - Street 1:2410 E RIVERSIDE DR
Mailing Address - Street 2:STE G3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3083
Mailing Address - Country:US
Mailing Address - Phone:512-448-4433
Mailing Address - Fax:512-448-3776
Practice Address - Street 1:2410 E RIVERSIDE DR
Practice Address - Street 2:STE G3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3083
Practice Address - Country:US
Practice Address - Phone:512-448-4433
Practice Address - Fax:512-448-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153715107Medicaid
TX153715105Medicaid