Individual
MR. MARK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5313 OGDEN ST, PHILADELPHIA, PA 19139-1438
(215) 600-9477
(215) 921-8499
Mailing address
5313 OGDEN ST, PHILADELPHIA, PA 19139-1438
(215) 600-9477
(215) 921-8499
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A-6418104
PA
Other
Enumeration date
04/23/2016
Last updated
04/23/2016
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