MEDICARE: WILSON COUDON 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	207RP1001X	Pulmonary Disease Physician	0101020537	VA

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

General Provider Information

NPI Number	:	1689667917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILSON COUDON MD

Provider Business Mailing Address
First Line	:	1400 S JOYCE ST
Second Line	:	SUITE 126
City	:	ARLINGTON
State	:	VA
Zip	:	22202-1872
Country	:	US
Telephone Number	:	703-521-6662
Fax Number	:	703-521-5991

Provider Business Practice Location Address
First Line	:	1400 S JOYCE ST
Second Line	:	SUITE 126
City	:	ARLINGTON
State	:	VA
Zip	:	22202-1872
Country	:	US
Telephone Number	:	703-521-6662
Fax Number	:	703-521-5991

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	09/10/2007

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Directions to “ WILSON COUDON MD” Practice Location

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