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General NPI Number Information
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NPI Number | 1194151316
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Entity Type | Individual
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Provider Name | WILTON L WILSON
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Gender | Male
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 4134 E JOPPA RD SUITE 202
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City | BALTIMORE
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State | MD
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Zip | 21236-2284
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Country | US
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Telephone | 410-248-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 WALTMAN RD
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City | EDGEWOOD
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State | MD
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Zip | 21040-2338
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R156587
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License Number State | MD
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