Individual
AUDREY R WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1815 COTTMAN AVE, PHILADELPHIA, PA 19111
(215) 742-5662
(215) 742-5663
Mailing address
980 US HIGHWAY 9, SOUTH AMBOY, NJ 08879
(732) 553-9729
(732) 553-9730
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD029434L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009479910015
—
PA
Enumeration date
03/07/2006
Last updated
07/08/2007
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