Provider Demographics
NPI:1275649824
Name:DAYLESFORD FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:DAYLESFORD FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:WILDMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:610-407-9490
Mailing Address - Street 1:1800 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1533
Mailing Address - Country:US
Mailing Address - Phone:610-407-9490
Mailing Address - Fax:610-407-9455
Practice Address - Street 1:1800 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1533
Practice Address - Country:US
Practice Address - Phone:610-407-9490
Practice Address - Fax:610-407-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010018L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty