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NPI Code Detail

MEDICARE: ROBERT S WILSON D.O.

MEDICARE: ROBERT S WILSON D.O.
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
1208D00000XGeneral Practice PhysicianOS-004237-LPA
2207QA0401XAddiction Medicine (Family Medicine) PhysicianOS-004237-LPA
3207QG0300XGeriatric Medicine (Family Medicine) PhysicianOS-004237-LPA

General Provider Information

NPI Number : 1245216068
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT S WILSON D.O.
Provider Business Mailing Address
First Line : 100 EAGLEVILLE RD
Second Line :
City : EAGLEVILLE
State : PA
Zip : 19403-1829
Country : US
Telephone Number : 610-539-6000
Fax Number : 610-539-9314
Provider Business Practice Location Address
First Line : 100 EAGLEVILLE RD
Second Line :
City : EAGLEVILLE
State : PA
Zip : 19403-1829
Country : US
Telephone Number : 610-539-6000
Fax Number : 610-539-9314
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 09/11/2025

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