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Provider Information for 1215907464

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

CELESTE RAQUEL WILSON M.D.

Gender: FEMALE

Individual NPI: 1215907464

Calendar   Last Updated:  2015-04-21
  Certification Date: 

Details

Name Value
NPI 1215907464
Enumeration Date 2006-01-23
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE WOLBACH 2
BOSTON, MA 02115-5724
United States

Phone: 617-355-6363 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE WOLBACH 2
BOSTON, MA 02115-5724
United States

Phone: 617-355-6363 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other NIEGHBORHOOD HEALTH MA 0015177
Other BLUE CROSS MA J23289
Other TUFTS MA 156465
Other CIGNA MA B501026
Other HARVARD PILGRIM MA PP788
MEDICAID MA 0114341
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2080C0008X - Pediatrics Child Abuse Pediatrics MA 156465
No 208000000X - Pediatrics MA 156465