Healthcare Provider Details

I. General information

NPI: 1932158912
Provider Name (Legal Business Name): JOCELYN B WOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21044 FREDERICK RD
GERMANTOWN MD
20876-4132
US

IV. Provider business mailing address

6124 JEFFERSON HWY
BATON ROUGE LA
70806-8015
US

V. Phone/Fax

Practice location:
  • Phone: 240-238-5432
  • Fax:
Mailing address:
  • Phone: 225-924-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101240125
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0093856
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024465
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: