ILI WATHEN PA-C
NPI 1063722577
Physician Assistant in Waldorf, MD

Active since October 18, 2010
3500 OLD WASHINGTON RD STE 201, WALDORF, MD 20602(301) 396-2003(240) 222-3134 Get Directions Write a Review

NPPES record last updated: July 28, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 21, 2025, Jan 9, 2020, Nov 5, 2019 (3 updates tracked since 2019).

About Ili Wathen Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ILI WATHEN PA-C (NPI 1063722577) is an individual physician assistant in Waldorf, Maryland, licensed in Maryland (C0004349) and active in the NPI registry since October 2010.

NPPES Registry Identity

NPI1063722577
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameILI WATHENCredential: PA-C
Location Address3500 OLD WASHINGTON RD STE 201Waldorf, MD 20602-3238
Mailing Address11565 Farm DrLa Plata, MD 20646-5417 · (301) 752-3667 · Fax (240) 222-3134
Fax(240) 222-3134
Sole ProprietorNo
Enumeration DateOctober 18, 2010
Last NPPES UpdateJuly 28, 20253 updates tracked since enumeration
NPPES CertifiedJuly 28, 2025
NPI 1063722577 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in MD · C0004349
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
3500 OLD WASHINGTON RD STE 201, Waldorf, MD 20602

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Acupuncturist
3500 OLD WASHINGTON RD STE 201
WALDORF, MD 20602

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ili Wathen's NPI number?

The NPI number for Ili Wathen is 1063722577. It was assigned to this individual provider in the NPPES registry on October 18, 2010.

Where is Ili Wathen located?

Ili Wathen practices at 3500 Old Washington Rd Ste 201, Waldorf, MD 20602. The listed phone number is (301) 396-2003.

What is Ili Wathen's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Ili Wathen was last updated on July 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.