Individual
JOHN EVERETT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D..O
Contact information
Practice address
4 C NORTH AVE, SUITE 425, BEL AIR, MD 21014-2307
(410) 838-8991
(410) 838-0727
Mailing address
4 C NORTH AVE, SUITE 425, BEL AIR, MD 21014-2307
(410) 838-8991
(410) 838-0727
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
H0045242
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H0045242
STATE LICENSE
MD
01
—
OW25NE
BCBS
MD
Enumeration date
10/04/2005
Last updated
08/26/2013
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