Individual
NICHOLAS JAMES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14010 SMOKETOWN RD STE 117, WOODBRIDGE, VA 22192-4722
(703) 580-0181
(703) 897-8763
Mailing address
14010 SMOKETOWN RD STE 117, WOODBRIDGE, VA 22192-4722
(703) 580-0181
(703) 897-8763
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT197046
PA
207RG0100X
Gastroenterology Physician
Primary
0101262381
VA
390200000X
Student in an Organized Health Care Education/Training Program
MT197046
PA
Other
Enumeration date
05/20/2010
Last updated
07/21/2022
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