MEDICARE: JOSHUA MICHAEL WILSON MD

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	207R00000X	Internal Medicine Physician	303164	NC
2	225200000X	Physical Therapy Assistant	2860	SC
3	208100000X	Physical Medicine & Rehabilitation Physician	61293903	WA

General Provider Information

NPI Number	:	1114263340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA MICHAEL WILSON MD

Provider Business Mailing Address
First Line	:	1000 BLYTHE BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5812
Country	:	US
Telephone Number	:	864-404-5239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST MAIN HOSPITAL
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-2234
Country	:	US
Telephone Number	:	206-598-3300
Fax Number	:

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

Provider Enumeration Date	:	12/15/2012
Last Update Date	:	02/08/2024

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