MEDICARE: JEFFREY C. WILSON, MD, RP LLC

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	2084P0800X	Psychiatry Physician	MD030440E	PA

General Provider Information

NPI Number	:	1225576168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY C. WILSON, MD, RP LLC

Provider Business Mailing Address
First Line	:	530 BROOKDALE DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15215-1018
Country	:	US
Telephone Number	:	412-721-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 FREEPORT RD
Second Line	:	#391
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-3103
Country	:	US
Telephone Number	:	412-781-3578
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY C WILSON
Credential	:	M.D.
Telephone Number	:	412-721-9050

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/13/2024

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