Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D32436 | MD |
Y | 2080P0207X | Pediatric Hematology-Oncologist | D32436 | MD |
NPI | 1063455368 |
---|---|
Provider Name | Dr. Joseph M Wiley |
First Address | Baltimore, MD 21215-5216 |
Second Address | Baltimore, MD 21215-5216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7987380 | (05) | MD |
CC3778 | R/R MEDICARE GROUP # (01) | MD |
D78203 | (02) | MD |