Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD451786 | PA |
NPI | 1063701316 |
---|---|
Provider Name | Dr. Lindsay Wilde |
First Address | Philadelphia, PA 19107-4216 |
Second Address | Philadelphia, PA 19107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 22/08/2018 |