Provider Demographics
NPI:1669402921
Name:WILSON, CHRISTINE B (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:B
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:HOPWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15445-2250
Mailing Address - Country:US
Mailing Address - Phone:724-437-2147
Mailing Address - Fax:724-438-8856
Practice Address - Street 1:1142 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:HOPWOOD
Practice Address - State:PA
Practice Address - Zip Code:15445-2250
Practice Address - Country:US
Practice Address - Phone:724-437-2147
Practice Address - Fax:724-438-8856
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29197207V00000X
PAMD070912L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018012760005Medicaid
038202LQ6Medicare ID - Type Unspecified
PA0018012760005Medicaid