ANDREW WILCOX MD, NPI 1154684074 — CUMBERLAND (MD)

NPI 1154684074

7+ Years Experience Individual

ANDREW WILCOX MD

06/18/2012
PROVIDER ENUMERATION DATE
07/17/2015
LAST UPDATE DATE
1154684074
NPI NUMBER

About ANDREW WILCOX

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

ANDREW WILCOX is a provider established in CUMBERLAND, MD. The NPI number of ANDREW WILCOX is 1154684074 and was assigned on 06/18/2012. The practitioners primary taxonomy code is: 207Q00000X with license number: D79747 MD .

Mailing address

  • City: HANCOCK
  • State: MD
  • Postal code: 217501518
  • Phone: 3016785187
  • Fax: 3016785797
  • Address: 109 RAYLOC DR

Primary Practice Address

  • Region : CUMBERLAND, MD
  • NPI : 1154684074
  • Phone : 3017223270
  • Fax : 3017223276
  • Postalcode : 215022878
  • Address : 621 KELLY RD

Additional identifiers

  • Identifier: 1154684074
  • Code / Type : 1 - other
  • Identifier state : MD
  • Identifier issuer: NPI

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: S865
  • Code / Type : 1 - other
  • Identifier state : MD
  • Identifier issuer : GROUP MEDICARE NUMBER

Provider taxonomy - Family Medicine

  • Taxonomy code: 207Q00000X
  • License number: D79747
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Contacts:

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  • ANDREW WILCOX MD
  • Address : 621 KELLY RD
  • Region : CUMBERLAND, MD
  • NPI : 1154684074
  • Phone : 3017223270
  • Fax : 3017223276
  • Postalcode : 215022878

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address621 KELLY RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCUMBERLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code215022878
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3017223270
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3017223276
The fax number associated with the location address of the provider being identified.
NPI1154684074
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1207Q00000X
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Provider Enumeration Date06/18/2012
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07/17/2015
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)ANDREW WILCOX
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address109 RAYLOC DR
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameHANCOCK
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code217501518
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3016785187
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3016785797
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1207Q00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Provider License Number 1D79747
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11154684074
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1MD
Other Provider Identifier State #1
Other Provider Identifier Issuer 1NPI
Other Provider Identifier Issuer #1
Other Provider Identifier 2S865
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2MD
Other Provider Identifier State #2
Other Provider Identifier Issuer 2GROUP MEDICARE NUMBER
Other Provider Identifier Issuer #2
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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