Provider Demographics
NPI:1053573303
Name:CHARLES F. WILSON, D.P.M., P.C.
Entity type:Organization
Organization Name:CHARLES F. WILSON, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-384-7687
Mailing Address - Street 1:13100 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3358
Mailing Address - Country:US
Mailing Address - Phone:301-384-7687
Mailing Address - Fax:301-236-4609
Practice Address - Street 1:13100 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3358
Practice Address - Country:US
Practice Address - Phone:301-384-7687
Practice Address - Fax:301-236-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD644213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD370458100Medicaid
MDT31230Medicare UPIN
MD370458100Medicaid
0438070001Medicare NSC