DR. ROGER M WILSON MD NPI 1245325794

NPI Information

NPI: 1245325794
Provider Name: DR. ROGER M WILSON, MD
Classification: Psychiatry & Neurology - 2084A0401X
Entity Type: Individual

Specialization: Addiction Medicine

PECOS Registration: Yes

Address:
DOROTHEA DIX AGENCY
BANGOR, ME
ZIP 04401
Phone: (207) 944-0733
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DR. Roger M Wilson, MD is an addiction medicine psychiatry neurology in Bangor, ME. The provider is a doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine DR. Roger M Wilson, MD NPI is 1245325794. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

DOROTHEA DIX AGENCY
BANGOR, ME
ZIP 04401
Phone: (207) 944-0733
Fax: (207) 288-3151

The NPI 1245325794 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/3/2006 and was last updated on 7/9/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084A0401X	Psychiatry & Neurology	Addiction Medicine	007254	MAINE	Yes
2	2084P0800X	Psychiatry & Neurology	Psychiatry	MD7254	MAINE	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	010211483	MEDICAID	MAINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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