Provider Demographics
NPI:1932201019
Name:WILSON, PETER W (PA-C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:WILSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:95 LEONARD AVE
Practice Address - Street 2:BUILDING 1, SUITE 202
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-206-0610
Practice Address - Fax:724-503-4156
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052493363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical