Individual
JOHN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 LADD RD, HANOVER, NH 03755-3420
(603) 448-0519
Mailing address
PO BOX 163, ETNA, NH 03750-0163
(603) 448-0519
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18519
WV
Other
Enumeration date
10/08/2015
Last updated
10/08/2015
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