MEDICARE: JOHN STEVEN 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	207RC0000X	Cardiovascular Disease Physician	MD052384L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0764259	OTHER		BS

General Provider Information

NPI Number	:	1689639270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN STEVEN WILSON MD

Provider Business Mailing Address
First Line	:	1034 GROVE ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2945
Country	:	US
Telephone Number	:	814-333-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	765 LIBERTY ST STE 105
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2567
Country	:	US
Telephone Number	:	814-373-2310
Fax Number	:	814-373-2313

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	05/28/2025

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Directions to “ JOHN STEVEN WILSON MD” Practice Location

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