Healthcare Provider Details

I. General information

NPI: 1588834931
Provider Name (Legal Business Name): AVERY WOOD MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BANK STREET
NORTH BENNINGTON VT
05257
US

IV. Provider business mailing address

PO BOX 726
NORTH BENNINGTON VT
05257-0726
US

V. Phone/Fax

Practice location:
  • Phone: 888-421-6801
  • Fax: 888-421-6801
Mailing address:
  • Phone: 888-421-6801
  • Fax: 888-421-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number430F01
License Number StateVT

VIII. Authorized Official

Name: DR. AVERY WOOD
Title or Position: OWNER
Credential: M.D.
Phone: 888-421-6801