Provider Demographics
NPI:1396045407
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:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-583-9600
Mailing Address - Street 1:2621 RIDGEPOINT DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5232
Mailing Address - Country:US
Mailing Address - Phone:512-583-9600
Mailing Address - Fax:
Practice Address - Street 1:2237 E RIVERSIDE DR
Practice Address - Street 2:SUITE 101-C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3051
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty