Individual
IRA B. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
299 CHESTNUT AVE, JAMAICA PLAIN, MA 02130-4415
(617) 522-4730
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
60627
MA
Other
Enumeration date
11/14/2006
Last updated
03/19/2012
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