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NPI Code Detail

MEDICARE: MRS. SUSAN MICHELLE WOOD MOTR/L

MEDICARE: MRS. SUSAN MICHELLE WOOD MOTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist945WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17280430OTHERWVAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31382862OTHERWVUMWA
4WV51916BOTHERWVHEALTH PLAN
5010718731007OTHERWVBC/BS
601071873100OTHERWVWV WORKERS' COMPENSATION
72103237OTHERWVOPTIMUM CHOICE

General Provider Information

NPI Number : 1487650107
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN MICHELLE WOOD MOTR/L
Provider Business Mailing Address
First Line : 306 W MAIN ST
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-1751
Country : US
Telephone Number : 304-842-3137
Fax Number : 304-842-3138
Provider Business Practice Location Address
First Line : 306 W MAIN ST
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-1751
Country : US
Telephone Number : 304-842-3137
Fax Number : 304-842-3138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 07/08/2007

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