MEDICARE: DR. ERIC P WILSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	MD050400L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040962PZP	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114927597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC P WILSON M.D.

Provider Business Mailing Address
First Line	:	1259 S CEDAR CREST BLVD
Second Line	:	SUITE 301
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6206
Country	:	US
Telephone Number	:	610-439-0372
Fax Number	:	610-439-8807

Provider Business Practice Location Address
First Line	:	600 COMMERCE BLVD
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6214
Country	:	US
Telephone Number	:	570-426-2960
Fax Number	:	570-426-2965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	09/05/2019

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Directions to “ DR. ERIC P WILSON M.D.” Practice Location

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