Provider Demographics
NPI:1003975400
Name:WILT, MARK F (P A)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:WILT
Suffix:
Gender:M
Credentials:P A
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Mailing Address - Street 1:193 SUGAR RD
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:PA
Mailing Address - Zip Code:15938-6016
Mailing Address - Country:US
Mailing Address - Phone:814-886-8491
Mailing Address - Fax:301-723-1480
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:SUITE 470
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:240-964-8724
Practice Address - Fax:240-964-8735
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-02-15
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Provider Licenses
StateLicense IDTaxonomies
MDC0003316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant