Provider Demographics
NPI:1659696854
Name:WILSON, MEGAN LOHR (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LOHR
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NE THORNTON PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-9000
Mailing Address - Country:US
Mailing Address - Phone:206-528-8000
Mailing Address - Fax:206-520-2399
Practice Address - Street 1:314 NE THORNTON PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-9000
Practice Address - Country:US
Practice Address - Phone:206-528-8000
Practice Address - Fax:206-520-2399
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60298955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1659696854Medicaid
WA1659696854Medicaid