Individual
NICHOLAS CHARLES WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5957 VT-7A, MANCHESTER CENTER, VT 05255
(802) 362-4440
Mailing address
5957 VT-7A, MANCHESTER CENTER, VT 05255
(802) 362-4440
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042.0015274
VT
390200000X
Student in an Organized Health Care Education/Training Program
MT215504
PA
Other
Enumeration date
06/18/2018
Last updated
07/21/2021
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