Provider Demographics
NPI:1699406967
Name:WILMOTH, THOMAS BRUCE II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRUCE
Last Name:WILMOTH
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:102 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3202
Mailing Address - Country:US
Mailing Address - Phone:302-650-2157
Mailing Address - Fax:
Practice Address - Street 1:1082 OLD CHURCHMANS RD STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2143
Practice Address - Country:US
Practice Address - Phone:302-655-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant