NPI 1063722577

Ili Wathen, PAC

Practitioner Physician Assistant Waldorf, MD

Practice location

Address: 3500 Old Washington Rd STE 201, Waldorf, MD 20602-3238
Phone: (301) 396-2003
Fax: (240) 222-3134
Mailing address: 11565 Farm Dr, La Plata, MD 20646-5417

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence C0004349 (MD)

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Registry record

NPI: 1063722577
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Oct 2010
Record last updated: 28 Jul 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.