Provider Demographics
NPI:1952338816
Name:WOOD, STEPHEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:136 ACADEMY STREET
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3102
Mailing Address - Country:US
Mailing Address - Phone:207-764-3917
Mailing Address - Fax:207-764-2499
Practice Address - Street 1:136 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-764-3917
Practice Address - Fax:207-764-2499
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2009-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME9830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114790000Medicaid
ME005228OtherANTHEM BC BS
ME005228OtherANTHEM BC BS
ME114790000Medicaid