Provider Demographics
NPI:1952490930
Name:WILDER, JAY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SCOTT
Last Name:WILDER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8901 WISCONSIN AVE.
Mailing Address - Street 2:WALTER REED NATIONAL MILITARY MEDICAL CTR
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-0196
Mailing Address - Fax:301-319-4712
Practice Address - Street 1:8901 WISCONSIN AVE.
Practice Address - Street 2:WALTER REED NATIONAL MILITARY MEDICAL CTR
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-0196
Practice Address - Fax:301-319-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-09-08
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Provider Licenses
StateLicense IDTaxonomies
DCMD11743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN