Provider Demographics
NPI:1386741742
Name:WILSON, DAVID COLE III (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:COLE
Last Name:WILSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 RICHMOND RD.
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-4000
Mailing Address - Country:US
Mailing Address - Phone:540-332-2153
Mailing Address - Fax:540-332-2210
Practice Address - Street 1:1355 RICHMOND RD.
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24402-4000
Practice Address - Country:US
Practice Address - Phone:540-332-2153
Practice Address - Fax:540-332-2210
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA36985204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7165030Medicaid
VAB06572Medicare UPIN