Individual
DR. PAMELA ANNE WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.O. FACOP
Contact information
Practice address
100 SOUTH ST, MEDICAL ARTS BUILDING, STE 207, SOUTHBRIDGE, MA 01550-4051
(508) 765-9700
(508) 765-9704
Mailing address
100 SOUTH ST, MEDICAL ARTS BUILDING, STE 207, SOUTHBRIDGE, MA 01550-4051
(508) 765-9700
(508) 765-9704
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
72206
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3066843
—
MA
Enumeration date
06/16/2006
Last updated
07/08/2007
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