Basic Information
| Provider Information | |||||||||
| NPI: | 1568752392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 834 CHESTNUT STREET, SUITE G-114 | ||||||||
| Address2: | THE PHILADELPHIA HAND CENTER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155213012 | ||||||||
| FaxNumber: | 2155213002 | ||||||||
| Practice Location | |||||||||
| Address1: | 834 CHESTNUT STREET, SUITE G-114 | ||||||||
| Address2: | THE PHILADELPHIA HAND CENTER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155213012 | ||||||||
| FaxNumber: | 2155213002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 03/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 172802 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | MD457056 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.