Provider Demographics
NPI:1588748263
Name:WILFRED, ELIZA NYLA (M D)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:NYLA
Last Name:WILFRED
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CHARTER CIR
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1614
Mailing Address - Country:US
Mailing Address - Phone:215-831-2913
Mailing Address - Fax:215-831-2929
Practice Address - Street 1:931 CHARTER CIR
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1614
Practice Address - Country:US
Practice Address - Phone:215-831-2913
Practice Address - Fax:215-831-2929
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065949L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017706160009Medicaid
PA028102GCRMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
PAG95795Medicare UPIN