Organization
MARTHA L WILSON MD PA
Active
Other names
MARTHA L WILSON MD PA PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTHA L WILSON M.D. (PRESIDENT)
(276) 238-9902
Entity
Organization
Contact information
Practice address
104 E STUART DR, GALAX, VA 24333-2119
(276) 238-9902
(276) 238-9907
Mailing address
104 E STUART DR, GALAX, VA 24333-2119
(276) 238-9902
(276) 238-9907
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
49D1001134
VA
207ND0101X
MOHS-Micrographic Surgery Physician
49D1001134
VA
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49D1001134
CLIA NUMBER
VA
Enumeration date
03/12/2007
Last updated
06/07/2010
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