Basic Information
| Provider Information | |||||||||
| NPI: | 1952490930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILDER | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8901 WISCONSIN AVE. | ||||||||
| Address2: | WALTER REED NATIONAL MILITARY MEDICAL CTR | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012950196 | ||||||||
| FaxNumber: | 3013194712 | ||||||||
| Practice Location | |||||||||
| Address1: | 8901 WISCONSIN AVE. | ||||||||
| Address2: | WALTER REED NATIONAL MILITARY MEDICAL CTR | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012950196 | ||||||||
| FaxNumber: | 3013194712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 09/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD11743 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.