Healthcare Provider Details

I. General information

NPI: 1053721340
Provider Name (Legal Business Name): REBECCA WOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC DEPARTMENT OF MEDICINE
LEBANON NH
03756-1000
US

IV. Provider business mailing address

273 COUNTY RD
NEW LONDON NH
03257-5736
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 603-526-5544
  • Fax: 603-526-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18458
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: