Provider Demographics
NPI:1437370970
Name:DANIEL W WILSON M D PLLC
Entity Type:Organization
Organization Name:DANIEL W WILSON M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-242-4601
Mailing Address - Street 1:7 E COVE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5024
Mailing Address - Country:US
Mailing Address - Phone:304-242-4601
Mailing Address - Fax:304-242-3765
Practice Address - Street 1:7 E COVE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5024
Practice Address - Country:US
Practice Address - Phone:304-242-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV016687290OtherMOUNTAIN STATE BLUE CROSS
WVDA5379OtherRAILROAD MEDICARE
WV9337801Medicare ID - Type Unspecified