Provider Demographics
NPI:1528064144
Name:WOOD, CHARLES OWEN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:OWEN
Last Name:WOOD
Suffix:
Gender:M
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:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-418-8000
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 160
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5900
Practice Address - Country:US
Practice Address - Phone:419-995-4960
Practice Address - Fax:419-995-4961
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027263207T00000X
KY41716207T00000X
NMMD2018-0985207T00000X
ND12978207T00000X
OH35C.001383207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100033060Medicaid
D41426Medicare UPIN
KY7100033060Medicaid
KY00594001Medicare PIN