Provider Demographics
NPI:1295704476
Name:WILDER, DEBORAH D (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:D
Last Name:WILDER
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 1:911 BRICK MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-3818
Mailing Address - Country:US
Mailing Address - Phone:301-774-2042
Mailing Address - Fax:301-774-2043
Practice Address - Street 1:21135 WHITFIELD PL
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7283
Practice Address - Country:US
Practice Address - Phone:703-430-7779
Practice Address - Fax:703-262-0906
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237400207V00000X
DCMD32212207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA178381OtherANTHEM
VA178381OtherANTHEM
G00896Medicare UPIN