Provider Demographics
NPI:1386628949
Name:WILSON, CHAD TERRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:TERRENCE
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:SURG HST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2066
Practice Address - Fax:617-724-3499
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA221129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery