| Dr Thomas A Wilson, MD | |
|
1010 Murray Ave, San Luis Obispo, CA 93405-1806 | |
| (805) 546-7692 | |
| (805) 546-7932 |
| Full Name | Dr Thomas A Wilson |
|---|---|
| Gender | Male |
| Speciality | Pediatrics - Pediatric Endocrinology |
| Location | 1010 Murray Ave, San Luis Obispo, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063454080 | NPI | - | NPPES |
| 00725544 | Medicaid | NY | |
| 4249553 | Other | NY | AETNA |
| 79A002 | Other | NY | EMPIRE BC.BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2080P0205X | Pediatrics - Pediatric Endocrinology | 151531 (New York) | Secondary |
| 2080P0205X | Pediatrics - Pediatric Endocrinology | G30444 (California) | Primary |
| Entity Name | Valley Childrens Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1437555265 PECOS PAC ID: 9032439336 Enrollment ID: O20150528001593 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Thomas A Wilson, MD Po Box 16012, San Luis Obispo, CA 93406-6012 Ph: () - | Dr Thomas A Wilson, MD 1010 Murray Ave, San Luis Obispo, CA 93405-1806 Ph: (805) 546-7692 |
Dr. Kathleen L Long, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1235 Osos St, Suite 100, San Luis Obispo, CA 93401 Phone: 805-549-0888 Fax: 805-549-8463 | |
Natasha Raja, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1010 Murray St, San Luis Obispo, CA 93405 Phone: 888-350-2911 Fax: 702-369-5827 | |
Dr. Rene Henry Bravo, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 620 California Blvd, Suite J, San Luis Obispo, CA 93401 Phone: 805-544-4460 | |
Dr. Susan Sharon Klaw Trout, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1235 Osos St Ste 100, San Luis Obispo, CA 93401 Phone: 805-549-0888 Fax: 805-549-8463 | |
Dr. Wanda L Lo, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1235 Osos St, Suite 100, San Luis Obispo, CA 93401 Phone: 805-549-0888 Fax: 805-549-8463 | |
Dr. Sarah Van Camp, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 1551 Bishop St, San Luis Obispo, CA 93401 Phone: 805-238-7250 |