Robert Marshall Wild Jr., M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD019167E Issued in PA

Practice address

905 University Dr
State College, PA 16801-6626

Phone

(814) 238-8418

Fax

(814) 234-2888

NPI assigned

Jan 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280793600000",
    "number": "1528047024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 UNIVERSITY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168016626",
            "telephone_number": "814-238-8418",
            "fax_number": "814-234-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 UNIVERSITY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168016626",
            "telephone_number": "814-238-8418",
            "fax_number": "814-234-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "ROBERT",
        "middle_name": "MARSHALL",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2010-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD019167E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006452750001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Alexis Whitney
• Lynn S Whittaker, CRNP
• Shyama Dilani Wickramaaratchi, D.O.
• Joseph P Wiedemer, MD
• Lori Wieder, LAPC, M.ED., NCC
• Erica Wiley, PHD
• James R Wilkes Jr., ATC
• Ben Graham Williams, DMD
• Courtney Renee Williams
• John Donald Williams, PH.D.

• Urology Physician in State College, PA
• Providers in State College, PA by specialty
• Urology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.