Individual
SEAN WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0001
(508) 856-2776
(508) 334-9108
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
264865
MA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
264865
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110104786A
—
MA
Enumeration date
09/13/2009
Last updated
09/18/2025
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