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NPI Code Detail

MEDICARE: BRIAN WILSON

MEDICARE: BRIAN 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
1207Q00000XFamily Medicine PhysicianMD069085LPA

General Provider Information

NPI Number : 1912947912
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN WILSON
Provider Business Mailing Address
First Line : 600 WATERCREST WAY
Second Line : SUITE 630
City : CHESWICK
State : PA
Zip : 15024-1370
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5769 SALTSBURG RD
Second Line :
City : VERONA
State : PA
Zip : 15147-3257
Country : US
Telephone Number : 412-793-8870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 04/06/2021

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Directions to “ BRIAN WILSON ” Practice Location

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