Healthcare Provider Details

I. General information

NPI: 1255393021
Provider Name (Legal Business Name): WILMINGTON MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 W LOCUST ST
WILMINGTON OH
45177-2009
US

IV. Provider business mailing address

1184 W LOCUST ST
WILMINGTON OH
45177-2009
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-1616
  • Fax:
Mailing address:
  • Phone: 937-382-1616
  • Fax: 937-382-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY INWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-382-1616