Individual
ELIZABETH T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
56 THOMAS JOHNSON DR, FREDERICK, MD 21702-4599
(301) 694-3111
(301) 694-8626
Mailing address
610 SOLAREX COURT, FREDERICK, MD 21703
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0002912
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
926580503
—
MD
05
—
926580505
—
MD
Enumeration date
01/23/2007
Last updated
08/02/2016
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