Provider Demographics
NPI:1003836784
Name:WILSON, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2050
Mailing Address - Fax:717-812-2052
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-2050
Practice Address - Fax:717-812-2052
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD04244L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20054653OtherAH MERCY-WMG READYCARE
PA740064OtherHIGHMARK BLUE SHIELD
PA01105903OtherCAPITAL BC-WMG SBFM
MD543248OtherCAREFIRST MD BCBS
PA81027OtherUNISON-WMG SBFM
PA50062680OtherCAPITAL BC-WMG READYCARE
PA1567482OtherGATEWAY WRC
PA186107OtherUNISON-WMG READYCARE
PA233297OtherMAMSI-WMG SBFM
PA5274049OtherAETNA
PA001409263Medicaid
PA030026OtherJOHNS HOPKINS
PAP002807OtherGATEWAY-WMG
PA1142442OtherAH MERCY-WMG SBFM
PA2161250OtherMAMSI-WMG READYCARE
PA38597OtherGEISINGER
PA740064OtherHIGHMARK
PA2161250OtherMAMSI-WMG READYCARE
PA20054653OtherAH MERCY-WMG READYCARE
PA186107OtherUNISON-WMG READYCARE
PAP002807OtherGATEWAY-WMG