Provider Demographics
NPI:1710927538
Name:WILSON, YVONNE F (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:F
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 1:30 TUSCAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3981
Mailing Address - Country:US
Mailing Address - Phone:857-282-8100
Mailing Address - Fax:781-653-0102
Practice Address - Street 1:30 TUSCAN BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3981
Practice Address - Country:US
Practice Address - Phone:857-282-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHT0383207R00000X
MA223444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206294Medicaid
NHAA137776OtherHARVARD PILGRIM HEALTHCARE NE
NH3006934OtherMVP
MA2130424Medicaid
NH1710927538OtherANTHEM BCBS NH
NHAA137776OtherHARVARD PILGRIM HEALTHCARE NE
MAI26225Medicare UPIN