Individual
DR. KELVEY RICHARDS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
130 FISHER RD, BERLIN, VT 05602-9516
(802) 371-4263
(802) 371-4481
Mailing address
PO BOX 547, ATT: CVMC FINANCE DEPT, BARRE, VT 05641-0547
(802) 371-4263
(802) 371-4481
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
042.0012164
VT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002401601
MEDICARE PTAN LINKED TO CVMC
VT
05
—
1019211
—
VT
Enumeration date
04/18/2008
Last updated
05/05/2014
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