Individual
CHARLES FREDERICK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
13100 NEW HAMPSHIRE AVE, SILVER SPRING, MD 20904-3358
(301) 384-7687
Mailing address
13100 NEW HAMPSHIRE AVE, SILVER SPRING, MD 20904-3358
(301) 384-7687
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
644
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2700037
EVERCARE NUMBER
MD
01
—
442618
MEDICARE NUMBER
MD
01
—
480002354
RAILROAD MEDICARE NUMBER
MD
01
—
8772
BC/BS FEDERAL
MD
Enumeration date
10/04/2006
Last updated
10/28/2021
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