Provider Demographics
NPI:1346519923
Name:MARIA CARMEN WILSON, P.A
Entity type:Organization
Organization Name:MARIA CARMEN WILSON, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-728-7803
Mailing Address - Street 1:14499 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 162
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2078
Mailing Address - Country:US
Mailing Address - Phone:813-961-0689
Mailing Address - Fax:813-265-0877
Practice Address - Street 1:14499 N DALE MABRY HWY
Practice Address - Street 2:SUITE 162
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2078
Practice Address - Country:US
Practice Address - Phone:813-961-0689
Practice Address - Fax:813-265-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty