Healthcare Provider Details

I. General information

NPI: 1467458760
Provider Name (Legal Business Name): DR. VIC WOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOMESTEAD AVE
WHEELING WV
26003-6638
US

IV. Provider business mailing address

PO BOX 6745
WHEELING WV
26003-0917
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-1020
  • Fax: 304-232-5674
Mailing address:
  • Phone: 304-233-9314
  • Fax: 304-233-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1142
License Number StateWV

VIII. Authorized Official

Name: VICTOR A WOOD
Title or Position: CEO
Credential: DO
Phone: 304-232-1020