Individual
DR. STEPHEN A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 MELNEA CASS BLVD, BOSTON, MA 02119-4401
(617) 414-2080
(617) 414-2090
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
283810
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110167078A
—
MA
05
—
3127148
—
NH
Enumeration date
06/05/2006
Last updated
02/09/2024
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