Provider Demographics
NPI:1508854274
Name:WILSON, ROBERT E (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-1757
Mailing Address - Fax:610-402-9089
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE #307
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6218
Practice Address - Country:US
Practice Address - Phone:610-402-1757
Practice Address - Fax:610-402-9089
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2013-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007250L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2008176OtherAMERIHEALTH MERCY
PA0123902OtherCAP. BLUE CROSS
PA1654173-002OtherCIGNA
PA814047OtherAETNA
PAP2749200OtherOXFORD
PA0016470690Medicaid
PA122852OtherTHREE RIVERS
PA30000037OtherKEYSTONE MERCY
PA0377814000OtherINDEP. BLUE CROSS
PA07952776OtherGATEWAY
PA952776OtherKHP CENTRAL
PA952776OtherHIGHMARK
PA07952776OtherGATEWAY
PA814047OtherAETNA
PA952776OtherKHP CENTRAL