Provider Demographics
NPI:1205888120
Name:WILSON, CLAUDIA M (MD)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1321 MICHAEL CT
Mailing Address - Street 2:STE 3
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1171
Mailing Address - Country:US
Mailing Address - Phone:718-352-1493
Mailing Address - Fax:718-771-8450
Practice Address - Street 1:629 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3339
Practice Address - Country:US
Practice Address - Phone:718-783-1200
Practice Address - Fax:718-771-8450
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY130158207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15A951Medicare PIN