Provider Demographics
NPI:1699833616
Name:WILSON, SIMON ARN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:ARN
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 1:6307 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5819
Mailing Address - Country:US
Mailing Address - Phone:240-418-2731
Mailing Address - Fax:
Practice Address - Street 1:11445 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5276
Practice Address - Country:US
Practice Address - Phone:703-709-1500
Practice Address - Fax:703-709-1516
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
007978M92Medicare ID - Type Unspecified
E72901Medicare UPIN