Provider Demographics
NPI:1851375174
Name:WOOD, VIRENDA D (MD)
Entity Type:Individual
Prefix:
First Name:VIRENDA
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 1:3523 MCKINNEY AVE
Mailing Address - Street 2:#263
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3523 MCKINNEY AVE
Practice Address - Street 2:#263
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1401
Practice Address - Country:US
Practice Address - Phone:214-912-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161216003Medicaid
TX161216008Medicaid
TX161216012Medicaid
TX161216016Medicaid
TX161216001Medicaid
TX161216006Medicaid
TX161216013Medicaid
TX161216014Medicaid
TX161216015Medicaid
TX161216005Medicaid
TX161216010Medicaid
TX8A8893Medicare ID - Type Unspecified
TX161216016Medicaid