Provider Demographics
NPI:1386106912
Name:WOOD, SAMUEL CLIFFORD (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CLIFFORD
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2233 WISCONSIN AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4104
Mailing Address - Country:US
Mailing Address - Phone:202-741-1250
Mailing Address - Fax:877-303-1460
Practice Address - Street 1:2233 WISCONSIN AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4104
Practice Address - Country:US
Practice Address - Phone:202-741-1250
Practice Address - Fax:877-303-1460
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD500002930207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine