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1164171690 NPI number — CONOR PATRICK WILSON DO

NPI Number: 1164171690
Health Care Provider/Practitioner: CONOR PATRICK WILSON DO

Information about “1164171690” NPI (CONOR PATRICK WILSON DO) exists in 1164171690 in HTML format HTML  |  1164171690 in plain Text format TXT  |  1164171690 in PDF (Portable Document Format) PDF  |  1164171690 in an XML format XML  formats.

NPI Number : 1164171690 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164171690",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "CONOR",
    "MiddleName": "PATRICK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1290 SILAS DEANE HWY",
    "SecondLineMailingAddress": "HHC-CVO",
    "MailingAddressCityName": "WETHERSFIELD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06109-4337",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-972-5507",
    "MailingAddressFaxNumber": "860-972-7040",
    "FirstLinePracticeLocationAddress": "200 RETREAT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HARTFORD",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06106-3309",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-545-7239",
    "PracticeLocationAddressFaxNumber": "860-545-7556",
    "EnumerationDate": "03/22/2022",
    "LastUpdateDate": "11/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "82562",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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