Provider Demographics
NPI:1932158912
Name:WOOD, JOCELYN B (MD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:B
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 1:6124 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8015
Mailing Address - Country:US
Mailing Address - Phone:225-924-6740
Mailing Address - Fax:
Practice Address - Street 1:21044 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4132
Practice Address - Country:US
Practice Address - Phone:240-238-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240125207Q00000X
MDD0093856207Q00000X
LA024465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559466Medicaid
LA4A312C822Medicare PIN
LA4A312Medicare ID - Type Unspecified
LA1559466Medicaid