Healthcare Provider Details

I. General information

NPI: 1235382771
Provider Name (Legal Business Name): DAVID J WOOD MD FRCPC,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 LOISDALE CT SUITE 155
SPRINGFIELD VA
22150-1828
US

IV. Provider business mailing address

6551 LOISDALE CT SUITE 155
SPRINGFIELD VA
22150-1828
US

V. Phone/Fax

Practice location:
  • Phone: 703-921-0692
  • Fax:
Mailing address:
  • Phone: 703-921-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101038559
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID JOHN WOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 703-921-0692