Provider Demographics
NPI:1245203629
Name:WILSON, WILLIAM ROBERT JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:333 BORTHWICK AVE
Mailing Address - Street 2:MOB 402
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-559-4111
Mailing Address - Fax:603-559-4110
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:STE 402
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-559-4111
Practice Address - Fax:603-559-4110
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-02-01
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Provider Licenses
StateLicense IDTaxonomies
ARE45752086S0129X
OH35.061928208G00000X
NH14182208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3099751Medicaid
NH3099751Medicaid
NHT400227728Medicare PIN
D99757Medicare UPIN