Provider Demographics
NPI:1881716009
Name:WOOD, ALISON FARNHAM (PA-C)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:FARNHAM
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:ISLESBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04848-0137
Mailing Address - Country:US
Mailing Address - Phone:207-734-2213
Mailing Address - Fax:207-734-8392
Practice Address - Street 1:150 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:ISLESBORO
Practice Address - State:ME
Practice Address - Zip Code:04848-0137
Practice Address - Country:US
Practice Address - Phone:207-734-2213
Practice Address - Fax:207-734-8392
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA834363AM0700X
ME513363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS47065Medicare UPIN