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NPI Code Detail

MEDICARE: DR. RALF G WILDNER MD

MEDICARE: DR. RALF G WILDNER MD
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
12084P0800XPsychiatry PhysicianMD060289LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093774986
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RALF G WILDNER MD
Provider Business Mailing Address
First Line : 100 NIKELLE LN
Second Line :
City : SOUTH ABINGTON TOWNSHIP
State : PA
Zip : 18411-2866
Country : US
Telephone Number : 570-586-2624
Fax Number :
Provider Business Practice Location Address
First Line : 500 SCHOOL ST
Second Line :
City : CLARKS SUMMIT
State : PA
Zip : 18411-1508
Country : US
Telephone Number : 570-586-3587
Fax Number : 570-586-0337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 10/28/2008

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