Provider Demographics
NPI:1821240144
Name:WILTON O'R NEDD MD PC
Entity Type:Organization
Organization Name:WILTON O'R NEDD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:O'REILLY
Authorized Official - Last Name:NEDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-529-1303
Mailing Address - Street 1:11514 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2281
Mailing Address - Country:US
Mailing Address - Phone:301-390-7331
Mailing Address - Fax:301-390-5699
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:STE.217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-529-1303
Practice Address - Fax:301-390-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14391208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026569100Medicaid
MD536910001Medicaid
081152Medicare PIN
E36828Medicare UPIN