Provider Demographics
NPI:1720192743
Name:WOOD, LISA D (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
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 1:1540 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9300
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9501
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:304-426-0262
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19616207R00000X, 208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0013508000Medicaid
WV7545258OtherAETNA
WV001721957OtherBLUE CROSS BLUE SHIELD
WV1045595OtherDWC
WVP00379507Medicare PIN
2030613Medicare PIN
2030612Medicare PIN
WV001721957OtherBLUE CROSS BLUE SHIELD
WVP00404648Medicare PIN
2030611Medicare PIN
WV1045595OtherDWC
WVG87760Medicare UPIN
DO4199033Medicare PIN
2030617Medicare PIN
D04199032Medicare PIN
2030615Medicare PIN
2030616Medicare PIN
110189055Medicare PIN