Provider Demographics
NPI:1134706625
Name:WOOD, MEAGHAN CECILIA (DPM)
Entity type:Individual
Prefix:DR
First Name:MEAGHAN
Middle Name:CECILIA
Last Name:WOOD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CHRISTOPHER LN STE 102A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1631
Mailing Address - Country:US
Mailing Address - Phone:143-512-2999
Mailing Address - Fax:
Practice Address - Street 1:43 STARR FARM RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-1321
Practice Address - Country:US
Practice Address - Phone:802-863-6384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135.001117213ES0103X
390200000X
VT056.0000210213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program