Individual
DR. IAN JERMAINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 SPINDRIFT DR, WILLIAMSVILLE, NY 14221-7891
(716) 631-2500
Mailing address
700 E MOREHEAD ST STE 300, CHARLOTTE, NC 28202-2742
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036169012
IL
2085R0202X
Diagnostic Radiology Physician
Primary
244637
NY
2085R0204X
Vascular & Interventional Radiology Physician
036169012
IL
2085R0204X
Vascular & Interventional Radiology Physician
244637
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02933948
—
NY
Enumeration date
07/20/2007
Last updated
02/24/2025
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