Wilson, Reginald Wendell

Wilson, Reginald Wendell is an individual health care provider with primary practice located at 19505 52Nd Ave W Suite A, Lynnwood WA 98036-5409. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Wilson, Reginald Wendell can be contacted via phone (206) 623-3814.

Contact Information

Primary practice address
19505 52Nd Ave W Suite A Lynnwood WA 98036-5409
Phone: (206) 623-3814
Fax: (206) 623-4327
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 030927 Georgia
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X MD 60318390 Washington

Profile Details

NPI number 1477517563
LBN Legal business name Wilson, Reginald Wendell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2006
Last updated May 11th, 2017 - about 9 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 1477517563 NPPES
Georgia MEDICAID 000787652A
Georgia Other 10049819
Georgia Other P00256641
Georgia Other 118365
Georgia Other 727301
Georgia Other 297058

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