Individual
BRANDON ALLAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2700 QUARRY LAKE DR STE 300, BALTIMORE, MD 21209-3746
(410) 377-8900
Mailing address
2700 QUARRY LAKE DR STE 300, BALTIMORE, MD 21209-3746
(410) 377-8900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C06974
MD
363AM0700X
Medical Physician Assistant
CN06974
MD
Other
Enumeration date
10/02/2018
Last updated
07/28/2022
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