Provider Demographics
NPI:1346304367
Name:WOOD, MICHAEL WARREN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WARREN
Last Name:WOOD
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 1:111 OSSIPEE TRL E STE 1153
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6421
Mailing Address - Country:US
Mailing Address - Phone:207-661-4850
Mailing Address - Fax:207-661-1212
Practice Address - Street 1:111 OSSIPEE TRL E STE 1153
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6421
Practice Address - Country:US
Practice Address - Phone:207-661-4850
Practice Address - Fax:207-642-1212
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MW1316670OtherDEA