Individual
DR. JENNIFER S WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20905 PROFESSIONAL PLZ, STE 330, ASHBURN, VA 20147-7783
(703) 726-0003
(703) 726-6444
Mailing address
PO BOX 791128, BALTIMORE, MD 21279-1128
(703) 726-0003
(703) 726-6444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101231146
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05647118
—
VA
01
—
P00009757
RR MEDICARE
—
Enumeration date
08/30/2005
Last updated
11/27/2023
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