Provider Demographics
NPI:1740346543
Name:WOOD, CHARLES G (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
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 1:4950 ESSEN LANE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3482
Mailing Address - Country:US
Mailing Address - Phone:225-767-0847
Mailing Address - Fax:225-766-1417
Practice Address - Street 1:4950 ESSEN LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3482
Practice Address - Country:US
Practice Address - Phone:225-767-0847
Practice Address - Fax:225-766-1417
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1820432085R0001X
LAMD.2015912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1019551Medicaid
LA4K6417290Medicare PIN
LA1019551Medicaid