Healthcare Provider Details

I. General information

NPI: 1164470332
Provider Name (Legal Business Name): ANTHONY E WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PROSPECT ST TRI-COUNTRY MEDICAL ASSOCIATES
MILFORD MA
01757-3003
US

IV. Provider business mailing address

9 INDUSTRIAL RD 5
MILFORD MA
01757-3736
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-1190
  • Fax:
Mailing address:
  • Phone: 508-473-1480
  • Fax: 508-473-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77482
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number77482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: