Charles L. Wilson, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD00016624 Issued in WA

Practice address

5402 47TH Ave NE
Seattle, WA 98105-2927

Phone

(206) 525-4090

Fax

(206) 985-2875

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vasectomy Clinic PC

  • Surgery Physician
  • Seattle, WA
  • NPI 1689095903
  NPD (past) Authorized official
• Seattle Primary Physicians, PLLC

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1043255961
  NPD (past)
• The Vasectomy Clinic, P.C.

  • Surgery Physician
  • Portland, OR
  • NPI 1740943869
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1376626309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5402 47TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981052927",
            "telephone_number": "206-525-4090",
            "fax_number": "206-985-2875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5402 47TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981052927",
            "telephone_number": "206-525-4090",
            "fax_number": "206-985-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHARLES",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00016624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7062144",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Wilson
• Ashley Nicole Wilson, PHARMD.
• Breyanna Paige Wilson
• Carl Wilson, LMT
• Carmen Wilson
• Christopher B Wilson
• Claire Elizabeth Wilson, MA, LMHCA
• Clyde H. Wilson, M.D.
• Cory Wilson, LMFT
• Cynthia Colleen Wilson, RN

• Surgery Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.