Provider Demographics
NPI:1053971606
Name:WILSON, MARCUS JOHN (DO)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:JOHN
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LATHAN LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4002
Mailing Address - Country:US
Mailing Address - Phone:252-672-0224
Mailing Address - Fax:252-672-0227
Practice Address - Street 1:1010 LATHAN LN
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4002
Practice Address - Country:US
Practice Address - Phone:252-672-0224
Practice Address - Fax:252-672-0227
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03221207Q00000X
MS28496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine