Individual
RICHARD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-4500
Mailing address
6 ARBOROUGH RD UNIT 2, ROSLINDALE, MA 02131-1602
(408) 438-3531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA101107
MA
Other
Enumeration date
07/24/2023
Last updated
12/19/2024
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