Individual
MRS. SUSAN MICHELLE WOOD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
306 W MAIN ST, BRIDGEPORT, WV 26330-1751
(304) 842-3137
(304) 842-3138
Mailing address
306 W MAIN ST, BRIDGEPORT, WV 26330-1751
(304) 842-3137
(304) 842-3138
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
945
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01071873100
WV WORKERS' COMPENSATION
WV
01
—
010718731007
BC/BS
WV
01
—
1382862
UMWA
WV
01
—
2103237
OPTIMUM CHOICE
WV
01
—
7280430
AETNA
WV
05
—
7505080-000
—
WV
01
—
WV51916B
HEALTH PLAN
WV
Enumeration date
06/27/2005
Last updated
07/08/2007
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