Provider Demographics
NPI:1427389808
Name:WILBER, RICHARD BERTRAM (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BERTRAM
Last Name:WILBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1746
Mailing Address - Country:US
Mailing Address - Phone:203-271-3250
Mailing Address - Fax:
Practice Address - Street 1:100 NOB HILL RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1746
Practice Address - Country:US
Practice Address - Phone:203-271-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028608208000000X, 2080P0208X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology