Provider Demographics
NPI:1669516761
Name:WILSON, ANNE S (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:SILBERGER
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:301-330-8011
Mailing Address - Fax:301-330-8014
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4608
Practice Address - Country:US
Practice Address - Phone:301-330-8011
Practice Address - Fax:301-330-8014
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD851000800Medicaid
MD415096100Medicaid
MD851000800Medicaid