Provider Demographics
NPI:1255486221
Name:WILSON, RICHARD ALPHONSO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALPHONSO
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-723-8000
Mailing Address - Fax:202-882-7333
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 315
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-723-8000
Practice Address - Fax:202-882-7333
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD11903207RR0500X
MDD0043663207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000783612OtherAMERICAN POSTAL WORKERS
521444579OtherUNITED HEALTHCARE
580P0762410001OtherCAREFIRST NATIONAL ACCOUN
521444579OtherNCPPO
0004053756OtherAETNA
DC010017400Medicaid
0735441OtherAETNA
521444579 20010 A001OtherTRICARE
0762OtherBLUE CROSS BLUE SHIELD
521444579OtherMAILHANDLERS
521444579 0001OtherCIGNA
105547OtherAMERIGROUP
521444579OtherVERIZON
521444579OtherKAISER
521444579 20010 A001OtherTRICARE
521444579OtherMAILHANDLERS