Provider Demographics
NPI:1629053111
Name:WOOD, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:16240 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4630
Practice Address - Country:US
Practice Address - Phone:540-825-5951
Practice Address - Fax:540-825-5971
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39501207Q00000X
CAG74883207Q00000X
VA0101043218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74883OtherBLUE CROSS
NC39501OtherNORTH CAROLINA MEDICAL BOARD LICENSE
CA00G748830OtherBLUE SHIELD OF CALIFORNIA
CA4415723OtherAETNA PIN
CA4415723OtherAETNA PIN
CA4415723OtherAETNA PIN
CA00G748830OtherBLUE SHIELD OF CALIFORNIA
CAE57224Medicare UPIN
NCBW2348958OtherDEA LICENSE
WG74883BMedicare PIN
NCNCQ824BMedicare PIN
NCNCQ824EMedicare PIN
CAG74883OtherBLUE CROSS