Provider Demographics
NPI:1588834931
Name:AVERY WOOD MD LLC
Entity type:Organization
Organization Name:AVERY WOOD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-421-6801
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-0726
Mailing Address - Country:US
Mailing Address - Phone:888-421-6801
Mailing Address - Fax:888-421-6801
Practice Address - Street 1:10 BANK STREET
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257
Practice Address - Country:US
Practice Address - Phone:888-421-6801
Practice Address - Fax:888-421-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT430F01261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014938Medicaid
VT1014938Medicaid