Provider Demographics
NPI:1780761247
Name:WILCOSKY, BERNARD R (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:R
Last Name:WILCOSKY
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 1:801 BREWSTER AVE
Mailing Address - Street 2:#945
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1557
Mailing Address - Country:US
Mailing Address - Phone:650-368-7246
Mailing Address - Fax:
Practice Address - Street 1:1016 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3919
Practice Address - Country:US
Practice Address - Phone:650-368-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG048990207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine