Active NPI
Carolyn Alice Wilson, MD
- Internal Medicine Physician
- Bangor, ME
National Provider Identifier
1053324293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 016114
- Practice address
- 304 Hancock St
Bangor VA Clinic
Bangor, ME 04401 - Phone
- (207) 561-3600
- Fax
- (207) 947-1862
- NPI assigned
- Aug 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 016114 | ME | Primary |
| Internal Medicine Physician | 207R00000X | 120975 | NC |
Addresses
Primary practice location
304 Hancock St
Bangor VA Clinic
Bangor, ME 04401
Mailing address
304 Hancock St
Bangor VA Clinic
Bangor, ME 04401
Phone (207) 561-3600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120975 | NC | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053324293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 HANCOCK ST",
"address_2": "BANGOR VA CLINIC",
"city": "BANGOR",
"state": "ME",
"postal_code": "04401",
"telephone_number": "207-561-3600",
"fax_number": "207-947-1862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 HANCOCK ST",
"address_2": "BANGOR VA CLINIC",
"city": "BANGOR",
"state": "ME",
"postal_code": "04401",
"telephone_number": "207-561-3600",
"fax_number": "207-947-1862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CAROLYN",
"middle_name": "ALICE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "ME",
"license": "016114",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "120975",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.