Provider Demographics
NPI:1942357496
Name:WILSON, NIAMEY SUSANNAH (MD)
Entity Type:Individual
Prefix:
First Name:NIAMEY
Middle Name:SUSANNAH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:860-714-6318
Mailing Address - Fax:860-714-9990
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:COMPREHENSIVE WOMEN'S HEALTH CENTER-BREAST CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-6318
Practice Address - Fax:860-714-9990
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT188433208600000X
CT532692086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology