Healthcare Provider Details

I. General information

NPI: 1467483750
Provider Name (Legal Business Name): JAMES WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WEST AVE
OCEAN CITY NJ
08226
US

IV. Provider business mailing address

PO BOX 366
OCEAN CITY NJ
08226-0366
US

V. Phone/Fax

Practice location:
  • Phone: 609-399-0700
  • Fax:
Mailing address:
  • Phone: 609-399-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMA040447
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: