Healthcare Provider Details

I. General information

NPI: 1134706625
Provider Name (Legal Business Name): MEAGHAN CECILIA WOOD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 STARR FARM RD
BURLINGTON VT
05408-1321
US

IV. Provider business mailing address

260 CHRISTOPHER LN STE 102A
STATEN ISLAND NY
10314-1631
US

V. Phone/Fax

Practice location:
  • Phone: 646-921-0907
  • Fax:
Mailing address:
  • Phone: 646-921-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number056.0000210
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6230
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135.001117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: