Provider Demographics
NPI:1003835034
Name:NEDD, WILTON O R (MD)
Entity Type:Individual
Prefix:
First Name:WILTON
Middle Name:O R
Last Name:NEDD
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 1:1310 SOUTHERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4623
Mailing Address - Country:US
Mailing Address - Phone:202-574-6055
Mailing Address - Fax:202-373-5956
Practice Address - Street 1:1328 SOUTHERN AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-574-6055
Practice Address - Fax:202-373-5956
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14391208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016400132Medicaid
MD536910001Medicaid
12902OtherCHARTERED HEALTH PLAN
54839OtherAMERIGROUP
0001OtherBLUE CROSS BLUE SHIELD
4835OtherELDER HEALTH
A745OtherBLUE CROSS BLUE SHIELD
N0564OtherHEALTHRIGHT
A745OtherBLUE CROSS BLUE SHIELD
E36828Medicare UPIN