Provider Demographics
NPI:1437159027
Name:WILCOX, DONNA GRAZIANO (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:GRAZIANO
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PALMER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057
Mailing Address - Country:US
Mailing Address - Phone:609-502-5575
Mailing Address - Fax:856-783-8083
Practice Address - Street 1:32 PALMER DRIVE
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:609-502-5575
Practice Address - Fax:856-783-8083
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB048773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52930Medicare UPIN
NJGR475274(DB3)Medicare ID - Type Unspecified