Provider Demographics
NPI:1659722619
Name:WILMOT, FIONA (MD)
Entity Type:Individual
Prefix:DR
First Name:FIONA
Middle Name:
Last Name:WILMOT
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 1:510 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1553
Mailing Address - Country:US
Mailing Address - Phone:510-433-1160
Mailing Address - Fax:510-452-8836
Practice Address - Street 1:1955 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1367
Practice Address - Country:US
Practice Address - Phone:510-433-1160
Practice Address - Fax:510-452-8836
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74321207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine