Healthcare Provider Details

I. General information

NPI: 1669402921
Provider Name (Legal Business Name): CHRISTINE B WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 NATIONAL PIKE
HOPWOOD PA
15445-2250
US

IV. Provider business mailing address

1142 NATIONAL PIKE
HOPWOOD PA
15445-2250
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-2147
  • Fax: 724-438-8856
Mailing address:
  • Phone: 724-437-2147
  • Fax: 724-438-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29197
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD070912L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: