Individual
KEVIN C. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 ALBANY ST, SHAPIRO 9, SUITE B, BOSTON, MA 02118-2526
(617) 638-7480
(617) 638-7486
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
159523
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010780
—
MA
Enumeration date
05/04/2006
Last updated
05/16/2014
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