MEDICARE: DEBORAH YVONNE WILSON M.D.

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	207W00000X	Ophthalmology Physician	D0050068	MD

General Provider Information

NPI Number	:	1174578744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH YVONNE WILSON M.D.

Provider Business Mailing Address
First Line	:	6510 KENILWORTH AVE
Second Line	:	SUITE 1300
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1339
Country	:	US
Telephone Number	:	301-699-1882
Fax Number	:	301-209-9456

Provider Business Practice Location Address
First Line	:	6510 KENILWORTH AVE
Second Line	:	SUITE 1300
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1339
Country	:	US
Telephone Number	:	301-699-1882
Fax Number	:	301-209-9456

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/28/2007

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