Provider Demographics
NPI:1215016761
Name:DRS WOOD AND EVANS-WOOD
Entity type:Organization
Organization Name:DRS WOOD AND EVANS-WOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZENBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-729-0060
Mailing Address - Street 1:17204 MCMULLEN HWY SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6214
Mailing Address - Country:US
Mailing Address - Phone:301-729-0060
Mailing Address - Fax:301-729-3100
Practice Address - Street 1:17204 MCMULLEN HWY SW
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6214
Practice Address - Country:US
Practice Address - Phone:301-729-0060
Practice Address - Fax:301-729-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6702033000Medicaid