Individual
WILLIAM L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
85 HERRICK ST, LAHEY AT BEVERLY HOSPITAL, BEVERLY, MA 01915-1790
(978) 922-3000
(978) 921-7048
Mailing address
85 HERRICK ST, LAHEY AT BEVERLY HOSPITAL, BEVERLY, MA 01915-1790
(978) 922-3000
(978) 921-7048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
22648
MN
207Q00000X
Family Medicine Physician
Primary
238644
MA
261QC1500X
Community Health Clinic/Center
238644
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110086079A
—
MA
01
—
55A04WI
BCBS
MN
05
—
755590300
—
MN
01
—
J47582
BCBS
MA
Enumeration date
08/20/2006
Last updated
03/03/2014
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