Provider Demographics
NPI:1871081646
Name:WILES, RON
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:WILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 MICHELE DR
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4562
Mailing Address - Country:US
Mailing Address - Phone:240-601-8665
Mailing Address - Fax:
Practice Address - Street 1:7849 MICHELE DR
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4562
Practice Address - Country:US
Practice Address - Phone:240-601-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services