Provider Demographics
NPI:1952161424
Name:WILSON, CHIDINMA MALISE (MD)
Entity Type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:MALISE
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 1:3131 WALNUT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3422
Mailing Address - Country:US
Mailing Address - Phone:951-536-8569
Mailing Address - Fax:
Practice Address - Street 1:3131 WALNUT ST APT 304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3422
Practice Address - Country:US
Practice Address - Phone:951-536-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program