Provider Demographics
NPI:1790003036
Name:ROBERT W. WILSON M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT W. WILSON M.D., P.C.
Other - Org Name:ASHBURN/RESTON FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEETRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-729-3700
Mailing Address - Street 1:1800 TOWN CENTER DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3215
Mailing Address - Country:US
Mailing Address - Phone:703-729-3700
Mailing Address - Fax:703-858-0675
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:SUITE 215
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3215
Practice Address - Country:US
Practice Address - Phone:703-729-3700
Practice Address - Fax:703-858-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization