Provider Demographics
NPI:1609827112
Name:WILSON, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4092 FOXWOOD DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5225
Mailing Address - Country:US
Mailing Address - Phone:757-467-4200
Mailing Address - Fax:757-422-1108
Practice Address - Street 1:4092 FOXWOOD DR
Practice Address - Street 2:SUITE #101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5225
Practice Address - Country:US
Practice Address - Phone:757-467-4200
Practice Address - Fax:757-422-1108
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101230329207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5854822Medicaid
G45091Medicare UPIN
VA5854822Medicaid