| Doctor Name: | KEITH D WILSON |
| NPI Number: | 1720248198 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | D71538 |
| Business Practice Address: | 11722 Reisterstown Rd Reisterstown, MD - 211363302 |
| Business Phone Number: | 4108335000 |
| Business Fax Number: | 4108331433 |
| Mailing Address: | Po Box 1708, GREENBELT |
| State: | MD |
| Postal Code: | 207681708 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2008 |
| NPI Last Update Date: | 05/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | D71538 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |