MEDICARE: DR. LYNNFORD S 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	207X00000X	Orthopaedic Surgery Physician	0101045190	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39620003	OTHER	DC	CAREFIRST OF DC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588645865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNFORD S WILSON M.D.

Provider Business Mailing Address
First Line	:	21475 RIDGETOP CIR
Second Line	:	STE 150
City	:	STERLING
State	:	VA
Zip	:	20166-6580
Country	:	US
Telephone Number	:	703-444-5000
Fax Number	:	703-444-4999

Provider Business Practice Location Address
First Line	:	21475 RIDGETOP CIR
Second Line	:	SUITE 150
City	:	STERLING
State	:	VA
Zip	:	20166-6580
Country	:	US
Telephone Number	:	703-444-5000
Fax Number	:	703-444-4999

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	12/02/2009

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