Provider Demographics
NPI:1639191521
Name:WOOD, ANGELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SWAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6309
Mailing Address - Country:US
Mailing Address - Phone:406-250-5625
Mailing Address - Fax:406-837-1401
Practice Address - Street 1:280 SWAN HILL DR
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6309
Practice Address - Country:US
Practice Address - Phone:406-250-5625
Practice Address - Fax:406-837-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTC23733Medicare UPIN