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NPI Code Detail

MEDICARE: DR. GAIL WILDER M.D.

MEDICARE:  DR. GAIL  WILDER  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician124349NY
2207P00000XEmergency Medicine Physician030574CT
3207P00000XEmergency Medicine Physician25MA05494300NJ
4207Q00000XFamily Medicine Physician25MA05494300NJ
5207R00000XInternal Medicine Physician124349NY
6207R00000XInternal Medicine Physician030574CT

General Provider Information

NPI Number : 1093144693
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAIL WILDER M.D.
Provider Business Mailing Address
First Line : 10 COOLRIDGE RD
Second Line :
City : MILFORD
State : CT
Zip : 06460-7620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 48 MONROE TPKE
Second Line :
City : TRUMBULL
State : CT
Zip : 06611-1341
Country : US
Telephone Number : 203-459-6512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2013
Last Update Date : 11/04/2013

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Directions to “ DR. GAIL WILDER M.D.” Practice Location

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