Healthcare Provider Details

I. General information

NPI: 1326249574
Provider Name (Legal Business Name): DR. NORMAN E. WOOD, JR, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24441 GARRETT HWY
MC HENRY MD
21541-1311
US

IV. Provider business mailing address

24441 GARRETT HWY
MC HENRY MD
21541-1311
US

V. Phone/Fax

Practice location:
  • Phone: 301-387-7777
  • Fax: 301-387-7756
Mailing address:
  • Phone: 301-387-7777
  • Fax: 301-387-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberH005600
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUSIE FAZENBAKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-729-0060