MEDICARE: MRS. MARIA WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	3747P1801X	Personal Care Attendant
3	374U00000X	Home Health Aide	HHA200003973	DC

General Provider Information

NPI Number	:	1093550451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA WILSON

Provider Business Mailing Address
First Line	:	1220 NORTHERN LIGHTS DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-6049
Country	:	US
Telephone Number	:	301-938-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 NORTHERN LIGHTS DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-6049
Country	:	US
Telephone Number	:	301-938-2154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/17/2026

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Directions to “ MRS. MARIA WILSON ” Practice Location

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