Individual
BEVERLY N WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12038 OCEAN GATEWAY, UNIT 1, OCEAN CITY, MD 21842
(410) 390-3341
(410) 390-3618
Mailing address
12038 OCEAN GATEWAY, UNIT 1, OCEAN CITY, MD 21842
(410) 390-3341
(410) 390-3618
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0006301
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0006301
MEDICAL LICENSE
MD
Enumeration date
12/13/2016
Last updated
09/11/2019
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