Provider Demographics
NPI:1023099033
Name:WILEY, VIRGINIA C (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C
Last Name:WILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:C
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 W FREDERICK ST
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8230
Practice Address - Country:US
Practice Address - Phone:301-845-6336
Practice Address - Fax:240-578-4478
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD926580505Medicaid
MD926580506Medicaid
MDM545Medicare PIN
MD926580505Medicaid
MDCD8143Medicare PIN
MD451LMedicare PIN