Healthcare Provider Details

I. General information

NPI: 1609784966
Provider Name (Legal Business Name): JONPAUL D WILSON PH MD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N PIERCE ST APT 1019
ARLINGTON VA
22209-3498
US

IV. Provider business mailing address

1300 N PIERCE STREET UNIT 1019
ARLINGTON VA
22209
US

V. Phone/Fax

Practice location:
  • Phone: 929-815-9682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: