DR. ROGER M WILSON (NPI# 1245325794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245325794 |
| Entity Type | Individual |
| Full Name | DR. ROGER M WILSON |
| Credential | MD |
| Practice Address |
Dorothea Dix Agency Bangor ME 04401 |
| Mailing Address |
18 Bridge Street Bar Harbor ME 04609 |
| Practice Telephone | 2079440733 |
| Practice Fax Number | 2072883151 |
| Mailing Telephone | 2072885082 |
| Mailing Fax Number | 2072887024 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
007254 | ME | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MD7254 | ME | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | 010211483 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609087717 | Roger J Wilson | Optometrist | 940 Commonwealth Ave, Suite 2, Boston, MA 02215-1203 | 2007-05-24 |
| 1861573594 | Roger Dale Wilson | Dentist | 8345 Walnut Hill Ln Ste 100, Dallas, TX 75231-4246 | 2006-10-18 |
| 1215032370 | Roger L. Wilson | Optometrist | 110 Solana Rd, Ponte Vedra Beach, FL 32082-2230 | 2006-09-14 |
| 1427064385 | Roger W Wilson | Optometrist | 1551 E Stop 12 Rd, Indianapolis, IN 46227-1006 | 2006-07-31 |
| 1851372775 | Roger W Wilson | Chiropractor | 200 Park Pl, Chagrin Falls, OH 44022-4456 | 2005-11-08 |
| 1598801896 | Roger Wilson | Case Manager/Care Coordinator | 30 Tremont St, Boscawen, NH 03303-1328 | 2007-01-30 |
| 1851475297 | Roger Lewis Wilson | Optometrist | 7721 E Main St, Reynoldsburg, OH 43068-1211 | 2006-10-24 |
| 1528001062 | Roger Wilson | Radiology | 2020 Palomino Ln, Suite 100, Las Vegas, NV 89106-4812 | 2006-06-13 |
| 1710931076 | Roger Wilson | Orthopaedic Surgery | 1140 W La Veta Avenue, Suite 860, Orange, CA 92868 | 2006-05-20 |
| 1437125721 | Roger Cave Wilson | Dentist | 3415 5th St, Rapid City, SD 57701-7365 | 2006-02-27 |
| Street Address |
DOROTHEA DIX AGENCY |
| City | BANGOR |
| State | ME |
| Zip Code | 04401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| 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 |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508091281 | Jonathan Carl Fellers | Psychiatry & Neurology | 550 Forest Ave Ste 103, Portland, ME 04101-1505 | 2009-05-25 |
| 1295875276 | Anthony J Kozma | Psychiatry & Neurology | 70 Center St Ste G7, Portland, ME 04101-3935 | 2007-02-07 |
| 1821079237 | James Fine | Psychiatry & Neurology | 43 Hooper St., Wiscasset, ME 04578 | 2005-11-11 |
| 1457823817 | Jonathan C Fellers Md Pa LLC | Psychiatry & Neurology | 550 Forest Ave Ste 103, Portland, ME 04101-1505 | 2018-12-26 |
| 1124448196 | Christopher Mark Buttarazzi | Psychiatry & Neurology | 254 Western Ave, South Portland, ME 04106-2410 | 2014-04-17 |
| 1689755530 | Broadleaf Behavioral Health PC | Psychiatry & Neurology | 9 Old Sawmill Ln, Arundel, ME 04046-8164 | 2006-10-18 |
| 1265464614 | Edward A Mccarthy | Psychiatry & Neurology | 144 State St, Portland, ME 04101-3776 | 2006-07-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.