Provider Demographics
NPI:1750316915
Name:WILSON, MARJORIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:75 FRANCIS STREET
Mailing Address - Street 2:BRIGHAM & WOMEN'S HOSPITAL-DEPT OF NEWBORN MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-8405
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET
Practice Address - Street 2:BRIGHAM & WOMEN'S HOSPITAL-DEPT OF NEWBORN MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA515062080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine