Provider Demographics
NPI:1194110718
Name:WILSON, JOHN STEWART JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEWART
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 GLEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3718
Mailing Address - Country:US
Mailing Address - Phone:724-837-5153
Mailing Address - Fax:
Practice Address - Street 1:220 GLEN FOREST DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3718
Practice Address - Country:US
Practice Address - Phone:724-837-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD007744E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology