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NPI Code Detail

MEDICARE: JOHN BENJAMIN WILSON M.D.

MEDICARE: JOHN BENJAMIN 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
1207P00000XEmergency Medicine PhysicianMD446902PA

General Provider Information

NPI Number : 1942520911
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN BENJAMIN WILSON M.D.
Provider Business Mailing Address
First Line : 1872 RIVERSIDE CIR
Second Line :
City : EASTON
State : PA
Zip : 18045-5669
Country : US
Telephone Number : 484-503-1201
Fax Number :
Provider Business Practice Location Address
First Line : 1872 RIVERSIDE CIR
Second Line :
City : EASTON
State : PA
Zip : 18045-5669
Country : US
Telephone Number : 484-503-1201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2010
Last Update Date : 06/26/2014

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