Provider Demographics
NPI:1881777811
Name:WILCHER, JOHN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:WILCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:SCOTT
Other - Last Name:WILCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7111 NORTH MAIN ST
Mailing Address - Street 2:STE 60
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2558
Mailing Address - Country:US
Mailing Address - Phone:937-276-3445
Mailing Address - Fax:937-276-2855
Practice Address - Street 1:7111 NORTH MAIN ST
Practice Address - Street 2:STE 60
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2558
Practice Address - Country:US
Practice Address - Phone:937-276-3445
Practice Address - Fax:937-276-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061598208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0855749Medicaid
F20623Medicare UPIN
OH4243131Medicare PIN
OHH383290Medicare PIN