Healthcare Provider Details

I. General information

NPI: 1417071366
Provider Name (Legal Business Name): DEVIN ANDREW WILES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WRAMC RM 2J38 6900 GEORGIA AVE. NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

2480 LLEWELLYN AVE
FORT GEORGE G MEADE MD
20755-7081
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-7241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number2287
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2287
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2287
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: