Provider Demographics
NPI:1477514305
Name:WOOD, KELLY ANN (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
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 1:71 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-5033
Mailing Address - Country:US
Mailing Address - Phone:412-657-7662
Mailing Address - Fax:
Practice Address - Street 1:ELM AND CARLTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-8679
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42015207RC0200X, 207RP1001X
PAMD072743L207RC0200X, 207RP1001X
VA0101058854207RC0200X, 207RP1001X
NY205799207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-122OtherTRICARE/CHAMPUS
VA1477514305Medicaid
NY205799OtherNYS LICENSE
VAPAROtherAETNA
PA001827933003Medicaid
VA0101058854OtherLICENSE
VA1477514305OtherCOVENTRY HEALTH NETWORK
NC5921779Medicaid
VAPAROtherMULTIPLAN
VA1477514305OtherUNITED HEALTHCARE
VA490247OtherANTHEM BC/BS
VAPAROtherVIRGINIA HEALTH NETWORK
TN3000364Medicaid
VAPAROtherCORVEL
VAPAROtherUSA MANAGED CARE
VA1477514305OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCIGNA
VA1477514305OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherMULTIPLAN
VAPAROtherCORVEL
TN3000364Medicare PIN