Provider Demographics
NPI:1831665595
Name:WILSON, BARRY CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:CHRISTOPHER
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 CASCADE MILL RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:VA
Mailing Address - Zip Code:24069-2548
Mailing Address - Country:US
Mailing Address - Phone:434-709-8798
Mailing Address - Fax:
Practice Address - Street 1:6470 CASCADE MILL RD
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:VA
Practice Address - Zip Code:24069-2548
Practice Address - Country:US
Practice Address - Phone:434-709-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-21
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT28404297343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)