Provider Demographics
NPI:1114927597
Name:WILSON, ERIC P (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1259 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6206
Mailing Address - Country:US
Mailing Address - Phone:610-439-0372
Mailing Address - Fax:610-439-8807
Practice Address - Street 1:600 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6214
Practice Address - Country:US
Practice Address - Phone:570-426-2960
Practice Address - Fax:570-426-2965
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD050400L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
040962PZPOtherMEDICARE
PA0018144070004Medicaid
PA040962LJYMedicare PIN