Provider Demographics
NPI:1346316494
Name:WIGGINS, S LATA (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:LATA
Last Name:WIGGINS
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 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-478-0038
Mailing Address - Fax:330-477-1383
Practice Address - Street 1:125 WHIPPLE AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1374
Practice Address - Country:US
Practice Address - Phone:330-478-0038
Practice Address - Fax:330-477-1383
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.044538208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0486862Medicaid
OHF62973Medicare UPIN