Provider Demographics
NPI:1437226453
Name:WILSON, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NORTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6009
Mailing Address - Country:US
Mailing Address - Phone:207-338-5440
Mailing Address - Fax:207-338-9380
Practice Address - Street 1:43 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:ME
Practice Address - Zip Code:04949
Practice Address - Country:US
Practice Address - Phone:207-589-4509
Practice Address - Fax:207-589-3104
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH28012Medicare ID - Type Unspecified