Provider Demographics
NPI:1558462937
Name:WILSON, EWAIN P (MD)
Entity type:Individual
Prefix:
First Name:EWAIN
Middle Name:P
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 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:810 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2762
Practice Address - Country:US
Practice Address - Phone:717-394-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091822207Y00000X
NC9801559207Y00000X
PAMD482706207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000579715OtherOHIO BLUE SHIELD- ANTHEM
OH300495104OtherNGS AMERICAN
OH0248771Medicaid
OHWI836742Medicare PIN
OH300495104OtherMEDICAL MUTUAL OF OHIO
OH00000579715OtherBCBS OF OHIO
OH300495104OtherOHIO HEALTH CHOICE
OH000000253990OtherUNISON
OH300495104OtherCIGNA
OH300495104OtherUNITED HEALTH CARE