Provider Demographics
NPI:1851506224
Name:WILSON, JAMES RONALD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RONALD
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 GLENVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5332
Mailing Address - Country:US
Mailing Address - Phone:203-661-4449
Mailing Address - Fax:
Practice Address - Street 1:2 GLENVILLE ROAD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5332
Practice Address - Country:US
Practice Address - Phone:203-661-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013697207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38117Medicare UPIN