Provider Demographics
NPI:1982866380
Name:ANNE S. WILSON, ASSOCIATES, PC
Entity Type:Organization
Organization Name:ANNE S. WILSON, ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-340-8012
Mailing Address - Street 1:14804 PHYSICIANS LN
Mailing Address - Street 2:SUITE 221
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3941
Mailing Address - Country:US
Mailing Address - Phone:301-340-8012
Mailing Address - Fax:301-340-8063
Practice Address - Street 1:14804 PHYSICIANS LN
Practice Address - Street 2:SUITE 221
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3941
Practice Address - Country:US
Practice Address - Phone:301-340-8012
Practice Address - Fax:301-340-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD851000800Medicaid
P266-8462OtherMEDICARE RAILROAD RETIREMENT BOARD
G85180Medicare UPIN
MD851000800Medicaid