Provider Demographics
NPI:1073568887
Name:WILDER, DAVID MICHAEL (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:WILDER
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 OAKLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2441
Mailing Address - Country:US
Mailing Address - Phone:703-764-8057
Mailing Address - Fax:
Practice Address - Street 1:11150 FAIRFAX BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5066
Practice Address - Country:US
Practice Address - Phone:703-934-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022015442083P0500X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine