Healthcare Provider Details

I. General information

NPI: 1275649824
Provider Name (Legal Business Name): DAYLESFORD FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LANCASTER AVE
PAOLI PA
19301-1533
US

IV. Provider business mailing address

1800 E LANCASTER AVE
PAOLI PA
19301-1533
US

V. Phone/Fax

Practice location:
  • Phone: 610-407-9490
  • Fax: 610-407-9455
Mailing address:
  • Phone: 610-407-9490
  • Fax: 610-407-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010018L
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID EVANS WILDMAN II
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 610-407-9490