Provider Demographics
NPI:1881312692
Name:MALDONADO, WILMER
Entity type:Individual
Prefix:
First Name:WILMER
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PIDGEON HILL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6134
Mailing Address - Country:US
Mailing Address - Phone:571-723-1833
Mailing Address - Fax:703-997-4067
Practice Address - Street 1:20 PIDGEON HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6134
Practice Address - Country:US
Practice Address - Phone:571-723-1833
Practice Address - Fax:703-997-4067
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)