Provider Demographics
NPI:1144399049
Name:WILTZ, MAGDALENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:
Last Name:WILTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLD NURSERY WAY
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18924
Mailing Address - Country:US
Mailing Address - Phone:215-794-0660
Mailing Address - Fax:215-752-5243
Practice Address - Street 1:930 TOWN CENTER DR
Practice Address - Street 2:SUITE G40
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3503
Practice Address - Country:US
Practice Address - Phone:215-757-1915
Practice Address - Fax:215-752-5243
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAMD022610E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41718Medicare UPIN
PAWI431391Medicare ID - Type Unspecified