Provider Demographics
NPI:1902067739
Name:WILSON, MATTHEW FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FRANCIS
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2295 N SUSQUEHANNA TRL STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-8495
Mailing Address - Country:US
Mailing Address - Phone:717-812-0731
Mailing Address - Fax:717-812-9848
Practice Address - Street 1:2295 N SUSQUEHANNA TRL STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-8495
Practice Address - Country:US
Practice Address - Phone:717-812-0731
Practice Address - Fax:717-812-9848
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014932207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOSO14932OtherLICENSE
PA102727766Medicaid
PA1027277660001Medicaid
PA1027277660001Medicaid