Provider Demographics
NPI:1770536971
Name:WILSON, CHRISTOPHER NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:NELSON
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5420 WADE PARK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4188
Mailing Address - Country:US
Mailing Address - Phone:919-233-5952
Mailing Address - Fax:919-854-7774
Practice Address - Street 1:8300 HEALTH PARK STE 213
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-896-7066
Practice Address - Fax:919-896-7067
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200401451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905501Medicaid
NC143XGOtherBCBS
NC143XGOtherBCBS