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General NPI Number Information
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NPI Number | 1962723817
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Entity Type | Individual
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Provider Name | RICHARD IAN WILSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 91 ENTERPRISE DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-9590
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Country | US
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Telephone | 252-451-3200
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Fax | 252-937-3107
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Provider Business Mailing Address
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Address Line | PO BOX 7200
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-0200
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Country | US
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Telephone | 252-937-0200
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Fax | 252-451-0056
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD465876
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2016-01141
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License Number State | NC
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