Individual
DR. DOUGLAS WILLIAM WISOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13700 ST FRANCIS BLVD STE 501, MIDLOTHIAN, VA 23114
(703) 914-8000
(703) 642-1876
Mailing address
11350 MCCORMICK ROAD, EXECUTIVE PLAZA 1, SUITE 501, HUNT VALLEY, MD 21031
(410) 329-1071
(410) 329-1054
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
010152685
VA
208VP0014X
Interventional Pain Medicine Physician
Primary
0101052685
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6802966
—
VA
Enumeration date
03/10/2006
Last updated
07/11/2019
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