MEDICARE: CHARLES C WOOD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110001510	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00013235	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	278240	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1104845049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES C WOOD PA

Provider Business Mailing Address
First Line	:	2636 LOUDOUN ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2438
Country	:	US
Telephone Number	:	757-301-9978
Fax Number	:	757-301-9978

Provider Business Practice Location Address
First Line	:	2636 LOUDOUN ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-2438
Country	:	US
Telephone Number	:	757-301-9978
Fax Number	:	757-301-9978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/07/2023

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Directions to “ CHARLES C WOOD PA” Practice Location

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