Individual
LARRY A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4924 CAMPBELL BLVD, BALTIMORE, MD 21236-5908
(443) 461-1997
Mailing address
PO BOX 759047, BALTIMORE, MD 21275-9047
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D26253
MD
Other
Enumeration date
09/09/2005
Last updated
03/27/2018
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