Provider Demographics
NPI:1992774053
Name:WILSON, JEFFREY C (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:WILSON
Suffix:
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 1:225 PENN AVE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2148
Mailing Address - Country:US
Mailing Address - Phone:412-371-1775
Mailing Address - Fax:412-371-3904
Practice Address - Street 1:225 PENN AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2148
Practice Address - Country:US
Practice Address - Phone:412-371-1775
Practice Address - Fax:412-371-3904
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030440E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
205489OtherUPMC HEALTH PLAN
0000024559OtherHIGHMARK BLUE CROSS
0000024559OtherGREENSPRING OF WEST PA
260019503OtherUNITED HEALTHCARE
PA00000024559OtherBLUE SHIELD
PA0011023000008Medicaid
1102300088OtherCOMMUNITY CARE
0000024559OtherGREENSPRING OF WEST PA
PA0011023000008Medicaid