Provider Demographics
NPI:1053398040
Name:WOOD, NICOLE A (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1937
Mailing Address - Country:US
Mailing Address - Phone:781-826-8065
Mailing Address - Fax:781-826-8043
Practice Address - Street 1:28 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1937
Practice Address - Country:US
Practice Address - Phone:781-826-8065
Practice Address - Fax:781-826-8043
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213942207Q00000X
NY282769207Q00000X
RIMD15206207Q00000X
MEMD20820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0180327Medicaid
MA713569OtherHARVARD PILGRIM
MA213942OtherTUFTS HEALTH PLAN
MAJ25178OtherBLUE CROSS BLUE SHIELD
MA713569OtherHARVARD PILGRIM
MAA34212Medicare PIN