Most Relevant Information
Provider Data
| NPI Number: | 1003347576 |
| Provider Name: | BRANDON DANIEL WILSON M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/25/2017 |
| Last Updated: | 04/07/2022 |
Provider Practice Location
800 WHEELING AVE
GLEN DALE
WV
260381660
Practice Location Phone/Fax
| Phone: | 3048453211 |
| Fax: |
Provider Mailing Location
222 NEWBERRY LN
MORGANTOWN
WV
265051078
Provider Mailing Phone/Fax
| Phone: | 3042818551 |
| Fax: |