Healthcare Provider Details

I. General information

NPI: 1962667477
Provider Name (Legal Business Name): WILLIAM ANTHONY WOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W OLIVE ST
SCRANTON PA
18508-2572
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-2100
  • Fax: 570-558-2101
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number042.0012429
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC1-0008988
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number19770
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number042.0012429
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD477476
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier3119344
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
IdentifierNH19770
Identifier TypeOTHER
Identifier StateNH
Identifier IssuerNH LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: