Provider Demographics
NPI:1952480733
Name:EHRMANTRAUT, WILFRED R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:R
Last Name:EHRMANTRAUT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 HOSPITAL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4040
Mailing Address - Country:US
Mailing Address - Phone:410-414-9844
Mailing Address - Fax:410-414-9795
Practice Address - Street 1:70 SHERRY LN
Practice Address - Street 2:SUITE 203
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3275
Practice Address - Country:US
Practice Address - Phone:410-414-9844
Practice Address - Fax:410-414-9795
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059299208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2956889OtherAETNA HMO
MD41312102OtherRENDERING BC/BS ID# MD
MD401242900Medicaid
MD1300392OtherUNITED HEALTHCARE
MD7534379OtherAETNA PPO
MDG616-0001OtherFEDERAL/DC/BLUECHOICE
MD3102788OtherALLIANCE
MDKDC3OtherCAREFIRST MARYLAND
MDKDC3OtherCAREFIRST MARYLAND
MD7534379OtherAETNA PPO