Provider Demographics
NPI:1861232704
Name:WOOD, DEANNA MARIE (ABOC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HARTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2817
Mailing Address - Country:US
Mailing Address - Phone:443-869-0705
Mailing Address - Fax:
Practice Address - Street 1:75 N EAST PLZ
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3617
Practice Address - Country:US
Practice Address - Phone:410-287-3723
Practice Address - Fax:410-287-3826
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135183156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician