Provider Demographics
NPI:1700977592
Name:WILSON, DANIEL WAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WAYNE
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7 E COVE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5024
Mailing Address - Country:US
Mailing Address - Phone:304-242-4601
Mailing Address - Fax:304-242-3765
Practice Address - Street 1:109 MOUNT WOOD RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2632
Practice Address - Country:US
Practice Address - Phone:304-233-2455
Practice Address - Fax:304-233-6073
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV13956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0051833000Medicaid
OH0633201Medicaid
WV0051833000Medicaid
OH0633201Medicaid