Provider Demographics
NPI:1710091616
Name:WOOD, DAVID RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
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 1:1830 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4014
Mailing Address - Country:US
Mailing Address - Phone:336-448-2427
Mailing Address - Fax:336-765-2869
Practice Address - Street 1:1901 S HAWTHORNE RD
Practice Address - Street 2:STE. 310
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3921
Practice Address - Country:US
Practice Address - Phone:336-448-2427
Practice Address - Fax:336-765-2869
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21242207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88875OtherBLUE CROSS BLUE SHIELD
NC8988875Medicaid
2901102OtherUNITED HEALTHCARE
NCP00924474OtherRR MEDICARE
NC8988875Medicaid
NC88875OtherBLUE CROSS BLUE SHIELD
NC202088DMedicare PIN