Individual
DR. MARK T WILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
401 ROGERS ST, PRINCETON, WV 24740-3636
(304) 487-9442
(330) 629-9181
Mailing address
PO BOX 365, PROSPERITY, WV 25909-0365
(800) 292-3008
(330) 629-9181
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
0103301014
VA
213E00000X
Podiatrist
10402
WV
213E00000X
Podiatrist
36-003486
OH
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103301014
VA
213ES0103X
Foot & Ankle Surgery Podiatrist
10402
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053580696
—
VA
05
—
3810015482
—
WV
01
—
P00733598
RAILROAD MEDICARE
—
Enumeration date
02/28/2008
Last updated
10/01/2009
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