MEDICARE: JOHN J WILSON MD

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	2085R0001X	Radiation Oncology Physician	MD422915	PA
2	2085R0001X	Radiation Oncology Physician	25MA08052600	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1902855455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J WILSON MD

Provider Business Mailing Address
First Line	:	200 BOWMAN DRIVE
Second Line	:	STE 190
City	:	VOORHEES TOWNSHIP
State	:	NJ
Zip	:	08043-9634
Country	:	US
Telephone Number	:	856-247-7370
Fax Number	:	856-247-7331

Provider Business Practice Location Address
First Line	:	200 BOWMAN DRIVE
Second Line	:	STE 190
City	:	VOORHEES TOWNSHIP
State	:	NJ
Zip	:	08043-9634
Country	:	US
Telephone Number	:	609-261-7074
Fax Number	:	856-247-7331

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/21/2022

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