Wild, Mark David

Wild, Mark David is an individual health care provider with primary practice located at 2728 Sunset Blvd Ste 201 , West Columbia SC 29169-4837. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Wild, Mark David can be contacted via phone (803) 254-1300.

Contact Information

Primary practice address
2728 Sunset Blvd Ste 201 West Columbia SC 29169-4837
Phone: (803) 254-1300
Fax: (803) 771-7597
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 20467 South Carolina

Profile Details

NPI number 1891759916
LBN Legal business name Wild, Mark David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2006
Last updated Jan 11th, 2024 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891759916 NPPES
South Carolina MEDICAID 204674

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