Healthcare Provider Details

I. General information

NPI: 1609714278
Provider Name (Legal Business Name): ISAAC KEITH WOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 COVE VIEW LN
MIDLOTHIAN VA
23112-4394
US

IV. Provider business mailing address

2907 COVE VIEW LN
MIDLOTHIAN VA
23112-4394
US

V. Phone/Fax

Practice location:
  • Phone: 804-307-8964
  • Fax: 804-237-0537
Mailing address:
  • Phone: 804-307-8964
  • Fax: 804-237-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ISAAC K WOOD
Title or Position: OWNER
Credential:
Phone: 804-763-9863