Provider Demographics
NPI:1952379919
Name:WOOD, STEVEN W (IDC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:WOOD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RYLAND RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1266
Mailing Address - Country:US
Mailing Address - Phone:540-286-1940
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC QUANTICO
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-6050
Practice Address - Country:US
Practice Address - Phone:703-784-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710I1002XOtherINDEPENDENT DUTY CORPSMAN