Provider Demographics
NPI:1316923006
Name:WILSON, CLAIRE D (MD)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:D
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2500
Practice Address - Fax:781-221-2510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA8204OtherHARVARD PILGRIM
MA4308304OtherCIGNA
MA6195954Medicaid
MA12-05000OtherUNITED HEALTHCARE
MAJ03141OtherBLUE CROSS
MA3547355OtherAETNA
MA0016001OtherNEIGHBORHOOD HEALTH
MA722797OtherTUFTS HEALTHCARE
MA6195954Medicaid