Basic Information
| Provider Information | |||||||||
| NPI: | 1255393021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILMINGTON MEDICAL ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1184 W LOCUST ST | ||||||||
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| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373821616 | ||||||||
| FaxNumber: | 9373827877 | ||||||||
| Practice Location | |||||||||
| Address1: | 1184 W LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373821616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | INWOOD | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9373821616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0157873 | 05 | OH | MEDICAID | 0288602 | 05 | OH | MEDICAID |