Provider Demographics
NPI:1659308799
Name:WOOD, JONATHON P (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:P
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:
Practice Address - Street 1:PICU PROFESSIONAL SERVICES EMMC
Practice Address - Street 2:489 STATE STREET
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-0404
Practice Address - Country:US
Practice Address - Phone:207-973-8670
Practice Address - Fax:207-973-5163
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME0159782080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG51874Medicare UPIN
MEMM9609Medicare ID - Type Unspecified