Provider Demographics
NPI:1659619963
Name:WOOD, PAULINE BUCKNELL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:BUCKNELL
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 1:2 NEOWAM AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-5718
Mailing Address - Country:US
Mailing Address - Phone:401-348-8089
Mailing Address - Fax:401-348-8727
Practice Address - Street 1:2 NEOWAM AVE
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-5718
Practice Address - Country:US
Practice Address - Phone:401-348-8089
Practice Address - Fax:401-348-8727
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine