Provider Demographics
NPI:1871581041
Name:WILD, CAROLYN A (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:A
Last Name:WILD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4545 POINT FOSDICK DR # 215
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1700
Mailing Address - Country:US
Mailing Address - Phone:253-530-8060
Mailing Address - Fax:253-530-8062
Practice Address - Street 1:4545 POINT FOSDICK DR # 215
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1700
Practice Address - Country:US
Practice Address - Phone:253-530-8060
Practice Address - Fax:253-530-8062
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60112482207RH0000X, 207RX0202X, 207RH0003X
WA60112482207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty