Provider Demographics
NPI:1679591234
Name:WOOD, SAMANTHA ANN (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 ELM ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1806
Mailing Address - Country:US
Mailing Address - Phone:812-537-4999
Mailing Address - Fax:812-537-5710
Practice Address - Street 1:5150 SANDY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2738
Practice Address - Country:US
Practice Address - Phone:513-896-9595
Practice Address - Fax:513-896-4171
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003004A207R00000X
OH34.006984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200544910AMedicaid
IN000000477618OtherANTHEM PROVIDER #
IN200544910AMedicaid
IN172420LMedicare ID - Type Unspecified