Healthcare Provider Details

I. General information

NPI: 1114410461
Provider Name (Legal Business Name): ANTHONY J WILSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST UNIT 1A
PORTSMOUTH NH
03801-3456
US

IV. Provider business mailing address

520 SOUTH ST
PORTSMOUTH NH
03801-5230
US

V. Phone/Fax

Practice location:
  • Phone: 603-294-4526
  • Fax: 603-590-2662
Mailing address:
  • Phone: 603-294-4526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY WILSON
Title or Position: OWNER
Credential: MD
Phone: 603-294-4526