Active NPI
Wayne S Wild, M.D.
- Internal Medicine Physician
- Watertown, MA
National Provider Identifier
1831238625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 36914
- Practice address
- 705 Mount Auburn Street
Tufts Health Plan
Watertown, MA 02472-1508 - Phone
- (617) 972-9400
- Fax
- (617) 972-9060
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 36914 | MA | Primary |
Addresses
Primary practice location
705 Mount Auburn Street
Tufts Health Plan
Watertown, MA 02472-1508
Mailing address
705 Mount Auburn Street
Tufts Health Plan
Watertown, MA 02472-1508
Phone (617) 972-9400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36914 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252022400000",
"number": "1831238625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 MOUNT AUBURN STREET",
"address_2": "TUFTS HEALTH PLAN",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024721508",
"telephone_number": "617-972-9400",
"fax_number": "617-972-9060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 MOUNT AUBURN STREET",
"address_2": "TUFTS HEALTH PLAN",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024721508",
"telephone_number": "617-972-9400",
"fax_number": "617-972-9060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILD",
"first_name": "WAYNE",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2009-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "36914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.