Lisa M Wiltrout, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D0057484 Issued in MD

Practice address

5 Garrett Ave
Civista Medical Center
La Plata, MD 20646-5960

Phone

(301) 609-4000

NPI assigned

Mar 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1306813134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CHARLES ST",
            "address_2": "P.O. BOX 1070",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465930",
            "telephone_number": "301-609-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVE",
            "address_2": "CIVISTA MEDICAL CENTER",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206465960",
            "telephone_number": "301-609-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILTROUT",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0057484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marion Williams
• Nicholas Curtis Williams, ATC/LAT
• Nyia Willis, BSW, ADT
• Willow Medical of Maryland, Inc.
• Caitlin Wilpone-Jordan
• Kirk Wingfield, LGPC
• Julie D Winkler, P.A.
• Patrick Carl Winters, D.C.
• Brittany Erin Wogamon, PHARMD
• Karima Woodfork, LGPC

• Pediatrics Physician in La Plata, MD
• Providers in La Plata, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.