Individual
MATTHEW A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
264 PLEASANT ST, CONCORD, NH 03301-2551
(603) 224-3368
(603) 224-7815
Mailing address
264 PLEASANT STREET, CONCORD, NH 03301-2551
(603) 224-3368
(603) 224-7815
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA714
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297110099
—
ME
05
—
3099683
—
NH
Enumeration date
06/15/2006
Last updated
11/16/2017
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