Provider Demographics
NPI:1346872488
Name:WOOD, CATHERINE FARNAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:FARNAN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 DANIEL STUART SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3317
Mailing Address - Country:US
Mailing Address - Phone:703-491-5600
Mailing Address - Fax:
Practice Address - Street 1:2079 DANIEL STUART SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3317
Practice Address - Country:US
Practice Address - Phone:703-491-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007728363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty