Wilson, Jack Edward

Wilson, Jack Edward is an individual health care provider with primary practice located at 3 Walnut St Ste 100 , Lemoyne PA 17043. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Wilson, Jack Edward can be contacted via phone (717) 761-4141.

Contact Information

Primary practice address
3 Walnut St Ste 100 Lemoyne PA 17043
Phone: (717) 761-4141
Fax: (717) 761-1456
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X MD025597E Pennsylvania

Profile Details

NPI number 1790756542
LBN Legal business name Wilson, Jack Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Jan 23rd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790756542 NPPES
Pennsylvania MEDICAID 000971496

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