Provider Demographics
NPI:1962440198
Name:MANSFIELD, WILMA A (MD)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:A
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-992-0060
Mailing Address - Fax:740-446-5154
Practice Address - Street 1:88 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-0060
Practice Address - Fax:740-446-5154
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-039790207Q00000X
WV21086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085062OtherCARESOURCE MEDICAID
WV0056270000Medicaid
OH0391759OtherMOLINA MEDICAID
001714086OtherMOUNTAIN STATE BCBS
080076943OtherRR MEDICARE
000000007616OtherANTHEM BCBS
OH000000181523OtherUNISON MEDICAID
OH0391759OtherMOLINA MEDICAID
080076943OtherRR MEDICARE
001714086OtherMOUNTAIN STATE BCBS