Healthcare Provider Details

I. General information

NPI: 1073774576
Provider Name (Legal Business Name): MARGARET L WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 11/02/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 ANDES RD
DELHI NY
13753-7407
US

IV. Provider business mailing address

460 ANDES RD
DELHI NY
13753-7407
US

V. Phone/Fax

Practice location:
  • Phone: 607-746-0550
  • Fax: 607-746-0568
Mailing address:
  • Phone: 607-746-0550
  • Fax: 607-746-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2011-0567
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2011-0567
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number317041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: