Provider Demographics
NPI:1063699569
Name:WILSON, VICTORIA V (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:V
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1380 PROGRESS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6498
Mailing Address - Country:US
Mailing Address - Phone:443-289-3400
Mailing Address - Fax:443-289-3480
Practice Address - Street 1:1380 PROGRESS WAY STE 102
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6498
Practice Address - Country:US
Practice Address - Phone:443-289-3400
Practice Address - Fax:443-289-3480
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2025-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0067957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420227900Medicaid
MD420227900Medicaid