Keith D Wilson Jr., MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

D71538 Issued in MD

Practice address

11722 Reisterstown Rd
Reisterstown, MD 21136-3302

Phone

(410) 833-5000

Fax

(410) 833-1433

NPI assigned

Jun 10, 2008

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

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• CHP MD Medical Affiliates, LLC

  • General Practice Physician
  • Owings Mills, MD
  • NPI 1326930306
  Medicare reassignment NPD
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1720248198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1708",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207681708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11722 REISTERSTOWN RD",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211363302",
            "telephone_number": "410-833-5000",
            "fax_number": "410-833-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KEITH",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MD",
            "license": "D71538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billie Jo Wendland, LCSW-C
• Dorothy Elise Wheeless, LCPC
• Brittany D White, L.G.S.W
• Whole Health Lifestyles LLC
• Ashley Alicia Willis, LCSWC
• Meghan Carney Wisniewski, DPT
• Wynisha Witt
• Nyeinpu Woah-Tee, FNP
• Yonas Woldu
• Cindy Wolff, R.N.

• General Practice Physician in Reisterstown, MD
• Providers in Reisterstown, MD by specialty
• General Practice Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.