Provider Demographics
NPI:1326080185
Name:WILMOTH, JASON G (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:WILMOTH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:994 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1802
Mailing Address - Country:US
Mailing Address - Phone:610-902-6092
Mailing Address - Fax:610-902-6081
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3714
Practice Address - Country:US
Practice Address - Phone:215-886-1482
Practice Address - Fax:215-886-1491
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073797L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018922340001Medicaid
PAH45880Medicare UPIN
PA050198Medicare ID - Type Unspecified