Provider Demographics
NPI:1710955505
Name:WILSON, CRISTI S (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTI
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-288-3069
Mailing Address - Fax:804-288-5464
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-288-3069
Practice Address - Fax:804-288-5464
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010453372080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF81648Medicare UPIN