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1659463305

NPI Code Detail

MEDICARE: DR. MARTA E WILD MD

MEDICARE: DR. MARTA E WILD 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
1	2084P0804X	Child & Adolescent Psychiatry Physician	176524	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	D0032863	MD
3	2084P0800X	Psychiatry Physician	D0032863	MD

General Provider Information

NPI Number	:	1659463305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTA E WILD MD

Provider Business Mailing Address
First Line	:	2509 ROCHELLE DR
Second Line	:
City	:	FALLSTON
State	:	MD
Zip	:	21047-2208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 PINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3124
Country	:	US
Telephone Number	:	562-595-1159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	03/17/2025

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Directions to “ DR. MARTA E WILD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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