Individual
KEITH D WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11722 REISTERSTOWN RD, REISTERSTOWN, MD 21136-3302
(410) 833-5000
(410) 833-1433
Mailing address
PO BOX 1708, GREENBELT, MD 20768-1708
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
D71538
MD
Other
Enumeration date
06/10/2008
Last updated
05/31/2011
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