Individual
ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 FOUNDERS PLZ STE 400, EAST HARTFORD, CT 06108-3240
(860) 289-3375
Mailing address
111 FOUNDERS PLZ STE 400, EAST HARTFORD, CT 06108-3240
(860) 289-3375
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
55002
MA
2085N0700X
Neuroradiology Physician
55002
MA
2085P0229X
Pediatric Radiology Physician
55002
MA
2085R0202X
Diagnostic Radiology Physician
55002
MA
2085R0204X
Vascular & Interventional Radiology Physician
55002
MA
2085U0001X
Diagnostic Ultrasound Physician
55002
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3056520
—
MA
Enumeration date
09/21/2005
Last updated
04/17/2020
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