Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 9857 | MD |
NPI | 1851875173 |
---|---|
Provider Name | Andrew Tyler Wilson |
First Address | Elkridge, MD 21075-5987 |
Second Address | Baltimore, MD 21236-4088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 13/10/2021 |