Healthcare Provider Details

I. General information

NPI: 1881674760
Provider Name (Legal Business Name): GEOFFREY WILLIAM WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE ANESTHESIOLOGY DEPT
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE ANESTHESIOLOGY DEPT
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-455-8778
  • Fax:
Mailing address:
  • Phone: 301-455-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101238779
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101238779
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: