Provider Demographics
NPI:1093876716
Name:MICHAEL M WYDILA MD PA
Entity Type:Organization
Organization Name:MICHAEL M WYDILA MD PA
Other - Org Name:ALLERGY ASSOCIATES PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WYDILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-798-8070
Mailing Address - Street 1:1403 SILVERSIDE RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4434
Mailing Address - Country:US
Mailing Address - Phone:302-798-8070
Mailing Address - Fax:302-798-5902
Practice Address - Street 1:1403 SILVERSIDE RD STE 4B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4434
Practice Address - Country:US
Practice Address - Phone:302-798-8070
Practice Address - Fax:302-798-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2625833000OtherKEYSTONE HEALTHPLAN EAST
DE4620757OtherAETNA
DEDE0802OtherPALMETTO GBA
PA2625833000OtherAMERIHEALTH
DEDE0802OtherPALMETTO GBA