Provider Demographics
NPI:1043747355
Name:WILSON, DANIEL NATHAN (CO, CPED)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:NATHAN
Last Name:WILSON
Suffix:
Gender:M
Credentials:CO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ALPHA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2908
Mailing Address - Country:US
Mailing Address - Phone:412-860-2854
Mailing Address - Fax:
Practice Address - Street 1:300 ALPHA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2908
Practice Address - Country:US
Practice Address - Phone:412-860-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPD000002224L00000X
PAOH000018222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist