1255486221 NPI number — DR. RICHARD ALPHONSO WILSON JR. M.D.

Table of content: (NPI 1417112822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255486221 NPI number — DR. RICHARD ALPHONSO WILSON JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
RICHARD
Provider Middle Name:
ALPHONSO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1255486221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 IRVING ST NW
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20010-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-723-8000
Provider Business Mailing Address Fax Number:
202-882-7333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 IRVING ST NW
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-723-8000
Provider Business Practice Location Address Fax Number:
202-882-7333
Provider Enumeration Date:
01/23/2007

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: 207RR0500X , with the licence number:  MD11903 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RR0500X , with the licence number: D0043663 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000783612 . This is a "AMERICAN POSTAL WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 580P0762410001 . This is a "CAREFIRST NATIONAL ACCOUN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004053756 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010017400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0735441 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 20010 A001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0762 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 . This is a "MAILHANDLERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 0001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 105547 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 . This is a "VERIZON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521444579 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com