1003836784 NPI number — DR. MICHAEL A WILSON MD

Table of content: DR. MICHAEL A WILSON MD (NPI 1003836784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003836784 NPI number — DR. MICHAEL A WILSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003836784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3421 CONCORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-812-2050
Provider Business Mailing Address Fax Number:
717-812-2052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4222 LINCOLN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17406-8083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-812-2050
Provider Business Practice Location Address Fax Number:
717-812-2052
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD04244L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20054653 . This is a "AH MERCY-WMG READYCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 740064 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01105903 . This is a "CAPITAL BC-WMG SBFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 543248 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 81027 . This is a "UNISON-WMG SBFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50062680 . This is a "CAPITAL BC-WMG READYCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1567482 . This is a "GATEWAY WRC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 186107 . This is a "UNISON-WMG READYCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 233297 . This is a "MAMSI-WMG SBFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5274049 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001409263 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030026 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P002807 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1142442 . This is a "AH MERCY-WMG SBFM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2161250 . This is a "MAMSI-WMG READYCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 38597 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 740064 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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