Type | Person | [sources] | |||
---|---|---|---|---|---|
Name | Samuel W. Wyld | [sources] | |||
Birth date | not available | [sources] | |||
Nationality | not available | [sources] | |||
Country | United States of America | [sources] | |||
First name | Samuel | [sources] | |||
ID Number | MA059106 | [sources] | |||
Last name | Wyld | [sources] | |||
Middle name | W. | [sources] | |||
NPI | 1558882779 | [sources] | |||
Title | PA-C · Physician Assistant | [sources] | |||
Address | (NY), (NY) | [sources] | |||
Last change | Last processed | First seen |
Medical providers who are precluded from participation in the Medical Assistance Program
United States of America · DHS
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Sanctions | |||||
---|---|---|---|---|---|
Country | Authority | Program | Start date | End date | |
United States of America | Department of Human Services | - |
Address | ||
---|---|---|
Full address | Country | |
(NY), (NY) · NY, NY | United States of America |