Individual
ELEANOR MCKENNA PITT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 706-4613
(410) 706-4619
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 706-4613
(410) 706-4619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
43321
TN
207RI0200X
Infectious Disease Physician
Primary
D78603
MD
207RI0200X
Infectious Disease Physician
MD042630
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
514029300
—
MD
01
—
S062-0580
CAREFIRST BC/BS
MD
Enumeration date
01/04/2007
Last updated
08/31/2015
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