Individual
DR. JACQUELINE DEANNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3737 MARKET STREET, 9TH FLOOR, PHILADELPHIA, PA 19104-5548
(215) 662-8777
(215) 243-4601
Mailing address
51 N 39TH ST, PPMC - MUTCH 7, PHILADELPHIA, PA 19104-5548
(215) 662-8777
(215) 243-4601
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD461194
PA
208000000X
Pediatrics Physician
MD461194
PA
2080A0000X
Pediatric Adolescent Medicine Physician
MD461194
PA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
MD461194
PA
Other
Enumeration date
05/02/2010
Last updated
04/09/2025
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