Healthcare Provider Details

I. General information

NPI: 1902067739
Provider Name (Legal Business Name): MATTHEW FRANCIS WILSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 03/07/2023
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 N SUSQUEHANNA TRL STE A
YORK PA
17404-8495
US

IV. Provider business mailing address

2295 N SUSQUEHANNA TRL STE A
YORK PA
17404-8495
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-0731
  • Fax: 717-812-9848
Mailing address:
  • Phone: 717-812-0731
  • Fax: 717-812-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014932
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS014932
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: