Individual
ROBERT H WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 PINE ST, NEW CANAAN, CT 06840-5408
(888) 663-6331
(415) 252-7176
Mailing address
632 BROADWAY PH 12, NEW YORK, NY 10012-2614
(347) 294-3414
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
256959
NY
207Q00000X
Family Medicine Physician
76440
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16639243
—
CO
Enumeration date
03/07/2007
Last updated
03/14/2025
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