Provider Demographics
NPI:1407574254
Name:WILSON, JOSHUA DAVID
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DAVID
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 COPPERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2827
Mailing Address - Country:US
Mailing Address - Phone:207-907-0361
Mailing Address - Fax:
Practice Address - Street 1:98 COPPERFIELD CT
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2827
Practice Address - Country:US
Practice Address - Phone:207-907-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program