Individual
ANDREW A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 ALBANY STREET, SHAPIRO 9, SUITE B, BOSTON, MA 02118-2526
(617) 638-7480
(617) 638-7486
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
217324
MA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
217324
MA
207RP1001X
Pulmonary Disease Physician
Primary
217324
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110076078A
—
MA
Enumeration date
10/23/2006
Last updated
07/11/2014
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