Provider Demographics
NPI:1952509408
Name:WILSON, ADRIAN I (DO)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:I
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-0151
Mailing Address - Country:US
Mailing Address - Phone:302-652-2455
Mailing Address - Fax:302-322-6251
Practice Address - Street 1:908 E 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-5145
Practice Address - Country:US
Practice Address - Phone:302-575-1414
Practice Address - Fax:302-575-1726
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0008403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1952509408Medicaid
DEC2-0008403OtherMEDICAL LICENSE
DE081803Medicare Oscar/Certification