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General NPI Number Information
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NPI Number | 1821973280
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Entity Type | Organization
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Legal Business Name | MAD RIVER HEALTH PLLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 859 OLD COUNTY RD
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City | WAITSFIELD
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State | VT
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Zip | 05673-6221
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Country | US
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Telephone | 802-496-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 859 OLD COUNTY RD
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City | WAITSFIELD
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State | VT
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Zip | 05673-6221
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Country | US
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Telephone | 802-496-6565
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JOHN A WILSON
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Credential | MD
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Telephone | 802-595-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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