Provider Demographics
NPI:1598765562
Name:WILSON, DENNIS NORMAN FARMER (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:NORMAN FARMER
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-633-9620
Mailing Address - Fax:704-633-7504
Practice Address - Street 1:401 MOCKSVILLE AVE FL 2
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2735
Practice Address - Country:US
Practice Address - Phone:704-633-9620
Practice Address - Fax:704-633-7504
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38575207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN38575Medicaid
NC8911868Medicaid
SCN38575Medicaid
NC2267513CMedicare PIN