| James Wilson Md Pllc | |
|
2500 Pond Vw Suite 204 Castleton NY 12033-9750 | |
| (518) 512-4166 | |
| (518) 512-4170 |
| Full Name | James Wilson Md Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 2500 Pond Vw, Castleton, New York |
| Authorized Official Name and Position | James Henry Wilson (MD/OWNER) |
| Authorized Official Contact | 5185124166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James Wilson Md Pllc 2500 Pond Vw Suite 204 Castleton NY 12033-9750 Ph: (518) 512-4166 | James Wilson Md Pllc 2500 Pond Vw Suite 204 Castleton NY 12033-9750 Ph: (518) 512-4166 |
| NPI Number | 1194082552 |
|---|---|
| Provider Enumeration Date | 04/23/2012 |
| Last Update Date | 04/23/2012 |
| Medicare PECOS PAC ID | 5799948469 |
|---|---|
| Medicare Enrollment ID | O20120516000084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194082552 | NPI | - | NPPES |
| 01820915 | Medicaid | NY | |
| 207773 | Other | NY | NYS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 207773 (New York) | Primary |
| Provider Name | James H Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518908045 PECOS PAC ID: 1557456258 Enrollment ID: I20070926000644 |
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