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General NPI Number Information
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NPI Number | 1225576168
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Entity Type | Organization
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Legal Business Name | JEFFREY C. WILSON, MD, RP LLC
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 1151 FREEPORT RD #391
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City | PITTSBURGH
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State | PA
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Zip | 15238-3103
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Country | US
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Telephone | 412-781-3578
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Fax |
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Provider Business Mailing Address
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Address Line | 530 BROOKDALE DR
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City | PITTSBURGH
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State | PA
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Zip | 15215-1018
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Country | US
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Telephone | 412-721-9050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY C WILSON
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Credential | M.D.
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Telephone | 412-721-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD030440E
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License Number State | PA
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