Provider Demographics
NPI:1891990990
Name:WILT, SARAH MAE NUNEZ (MD)
Entity Type:Individual
Prefix:
First Name:SARAH MAE
Middle Name:NUNEZ
Last Name:WILT
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 1:102 ROCKCREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8915
Mailing Address - Country:US
Mailing Address - Phone:864-725-5020
Mailing Address - Fax:
Practice Address - Street 1:102 ROCKCREEK BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-8915
Practice Address - Country:US
Practice Address - Phone:864-725-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC298396Medicaid
SCSC2874Medicare PIN
SCRES0001124Medicare PIN
SCRES000Medicare UPIN