Provider Demographics
NPI:1417997388
Name:WOOD, RICHARD MILHOUS (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MILHOUS
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BINGHAM MILLS RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5409
Mailing Address - Country:US
Mailing Address - Phone:845-546-3403
Mailing Address - Fax:866-844-7209
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3739
Practice Address - Country:US
Practice Address - Phone:845-546-3403
Practice Address - Fax:866-844-7209
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2210941208600000X
CT041445208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02188925Medicaid
G82715Medicare UPIN
NYWJD601Medicare PIN