Provider Demographics
NPI:1720344906
Name:WILSON, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 ULUKAHIKI ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4454
Mailing Address - Country:US
Mailing Address - Phone:808-263-5174
Mailing Address - Fax:808-266-3614
Practice Address - Street 1:640 ULUKAHIKI ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4454
Practice Address - Country:US
Practice Address - Phone:808-263-5174
Practice Address - Fax:808-266-3614
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine