Individual
DR. ROGER M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
DOROTHEA DIX AGENCY, BANGOR, ME 04401
(207) 944-0733
(207) 288-3151
Mailing address
18 BRIDGE STREET, BAR HARBOR, ME 04609
(207) 288-5082
(207) 288-7024
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
007254
ME
2084P0800X
Psychiatry Physician
MD7254
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010211483
—
ME
Enumeration date
10/03/2006
Last updated
07/09/2019
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