Healthcare Provider Details

I. General information

NPI: 1073577888
Provider Name (Legal Business Name): BRIAN EDWIN WOOD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 BRAEBURN DR STE 130
SALEM VA
24153-7304
US

IV. Provider business mailing address

2000 HEALTH PARK DR FL HP2
BRENTWOOD TN
37027-4692
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-0460
  • Fax:
Mailing address:
  • Phone: 615-373-7600
  • Fax: 877-767-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0102037202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: