Individual
DR. RODGERS M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-4600
(215) 831-6984
Mailing address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-4600
(215) 831-6984
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD424283
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101127811-001
—
PA
Enumeration date
05/11/2006
Last updated
05/08/2012
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