Healthcare Provider Details

I. General information

NPI: 1912540576
Provider Name (Legal Business Name): ISAAC KEITH WOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 STONY POINT PKWY STE 365
RICHMOND VA
23235-1947
US

IV. Provider business mailing address

9020 STONY POINT PKWY STE 365
RICHMOND VA
23235-1947
US

V. Phone/Fax

Practice location:
  • Phone: 804-763-9863
  • Fax: 804-237-0980
Mailing address:
  • Phone: 804-763-9863
  • Fax: 804-237-0980

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 KEITH WOOD
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 804-307-8964