Provider Demographics
NPI:1093715179
Name:WILSON, FREDERICK ROCKEY (DO)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ROCKEY
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-0716
Mailing Address - Country:US
Mailing Address - Phone:724-704-8886
Mailing Address - Fax:724-342-1942
Practice Address - Street 1:2000 GREEN ST BLDG B
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1399
Practice Address - Country:US
Practice Address - Phone:724-342-6900
Practice Address - Fax:724-342-6905
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004015L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31723Medicare UPIN