Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD048911L | PA |
NPI | 1033117130 |
---|---|
Provider Name | Dr. Mark Spencer Wilcox |
First Address | Pittsburgh, PA 15243-1873 |
Second Address | Pittsburgh, PA 15243-1873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014664750002 | (05) | PA |
F81658 | (02) |