Healthcare Provider Details

I. General information

NPI: 1053398040
Provider Name (Legal Business Name): NICOLE A. WOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 RIVERSIDE DR
PEMBROKE MA
02359-1937
US

IV. Provider business mailing address

28 RIVERSIDE DR
PEMBROKE MA
02359-1937
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-8065
  • Fax: 781-826-8043
Mailing address:
  • Phone: 781-826-8065
  • Fax: 781-826-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number213942
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number282769
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15206
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20820
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: