Individual
MARK MEREDITH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF PULMONARY MEDICINE, WORCESTER, MA 01655-0002
(508) 856-3121
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
72519
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110051153A
—
MA
Enumeration date
12/05/2005
Last updated
11/02/2020
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