Individual
ILI WATHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3500 OLD WASHINGTON RD STE 201, WALDORF, MD 20602-3238
(301) 396-2003
(240) 222-3134
Mailing address
11565 FARM DR, LA PLATA, MD 20646-5417
(301) 752-3667
(240) 222-3134
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0004349
MD
Other
Enumeration date
10/18/2010
Last updated
07/28/2025
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