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NPI Code Detail

MEDICARE: BRANDON WILSON

MEDICARE: BRANDON WILSON
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
12084P0800XPsychiatry Physician39353NH
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1780334862
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON WILSON
Provider Business Mailing Address
First Line : 1 MEDICAL CENTER DR
Second Line : DEPT OF PSYCHIATRY
City : LEBANON
State : NH
Zip : 03756-1000
Country : US
Telephone Number : 603-650-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1 MEDICAL CENTER DR
Second Line : DEPT OF PSYCHIATRY
City : LEBANON
State : NH
Zip : 03756-1000
Country : US
Telephone Number : 603-650-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2022
Last Update Date : 06/16/2026

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