Provider Demographics
NPI:1528219417
Name:WILSON, NICHOLA CAROLYN (MBCHB)
Entity Type:Individual
Prefix:
First Name:NICHOLA
Middle Name:CAROLYN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 BONNIE RIDGE DR
Mailing Address - Street 2:APT 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1922
Mailing Address - Country:US
Mailing Address - Phone:443-857-6147
Mailing Address - Fax:
Practice Address - Street 1:601 N CAROLINE ST JHOC # 5215
Practice Address - Street 2:JOHNS HOPKINS DEPARTMENT OF ORTHOPAEDIC SURGERY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23741207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery