Provider Demographics
NPI:1922234970
Name:WILSON, JAMES CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CRAIG
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7902
Mailing Address - Country:US
Mailing Address - Phone:207-624-6800
Mailing Address - Fax:207-624-4801
Practice Address - Street 1:442 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7902
Practice Address - Country:US
Practice Address - Phone:207-624-6800
Practice Address - Fax:207-624-4801
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20241208100000X
VA390200000X
UT8572663-1205208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine