Provider Demographics
NPI:1740309582
Name:WILSON, DONNA (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WILSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:2087 ROUTE 9 STE 9
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1148
Practice Address - Country:US
Practice Address - Phone:609-486-5150
Practice Address - Fax:609-486-6798
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08173300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFW0138405OtherDEA