Provider Demographics
NPI:1689667917
Name:COUDON, WILSON (MD)
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:COUDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 S JOYCE ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-1872
Mailing Address - Country:US
Mailing Address - Phone:703-521-6662
Mailing Address - Fax:703-521-5991
Practice Address - Street 1:1400 S JOYCE ST
Practice Address - Street 2:SUITE 126
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-1872
Practice Address - Country:US
Practice Address - Phone:703-521-6662
Practice Address - Fax:703-521-5991
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101020537207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6096174Medicaid
VAB93641Medicare UPIN
VA6096174Medicaid