Provider Demographics
NPI:1659333920
Name:WILEN, HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:WILEN
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 1:1200 BROOKS LN
Mailing Address - Street 2:SUITE G10
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-5914
Mailing Address - Fax:412-469-7004
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE G10
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-469-5914
Practice Address - Fax:412-469-7004
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031985E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011248170001Medicaid
PA108119Medicare ID - Type Unspecified
PA0011248170001Medicaid