Provider Demographics
NPI:1841476868
Name:MORALES, WIL (PA)
Entity type:Individual
Prefix:MR
First Name:WIL
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4530 BENNION RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4677
Mailing Address - Country:US
Mailing Address - Phone:619-248-7992
Mailing Address - Fax:
Practice Address - Street 1:1 SAN DIEGO LOOP BLDG 3282
Practice Address - Street 2:ANDREWS AFB
Practice Address - City:ANDREWS AIR FORCE BASE
Practice Address - State:MD
Practice Address - Zip Code:20762-5518
Practice Address - Country:US
Practice Address - Phone:240-857-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical