Provider Demographics
NPI:1770573867
Name:WILSON, FLETCHER R (MD)
Entity type:Individual
Prefix:DR
First Name:FLETCHER
Middle Name:R
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 1:201 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6763
Mailing Address - Country:US
Mailing Address - Phone:603-668-8400
Mailing Address - Fax:603-626-7368
Practice Address - Street 1:201 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6763
Practice Address - Country:US
Practice Address - Phone:603-668-8400
Practice Address - Fax:603-626-7368
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11227207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074208Medicaid
NH1328500OtherCIGNA
NHNH2058OtherHARVARD
NH30201473Medicaid
NH783039OtherMVP
NH01Y003120NH01OtherBLUE CROSS BLUE SHIELD
NH3738633OtherAETNA
NH3738633OtherAETNA
NHH45045Medicare UPIN