Provider Demographics
NPI:1154741080
Name:WILSON, DALE RICHARD JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:RICHARD
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1300 HELICOPTER RD BLDG 3854
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-8913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 HELICOPTER RD BLDG 3854
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8913
Practice Address - Country:US
Practice Address - Phone:757-763-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2023-05-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant