GLEN P WILSON (NPI# 1285638999) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285638999 |
| Entity Type | Individual |
| Full Name | GLEN P WILSON |
| Credential | M.D. |
| Practice Address |
4901 Lang Ave Ne Albuquerque NM 87109-4495 |
| Practice Telephone | 5058428171 |
| Practice Fax Number | 5058573877 |
| Mailing Telephone | 5058428171 |
| Mailing Fax Number | 5058573877 |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2017-01-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
2000-314 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 52713 | 05 | |
| NM | MEDICARE GROUP | 700521102 | 01 |
| NM | MEDICARE IDTF | 800521126 | 01 |
| NM | MEDICARE IDTF | 600521002 | 01 |
| NM | L0634 | 05 | |
| NM | 45138 | 05 | |
| NM | MEDICARE GROUP | 2258272 | 01 |
| NM | 66463 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154710960 | Glen Wilson | Social Worker | 9876 Main St Ste 100, Woodstock, GA 30188-3990 | 2015-01-16 |
| Street Address |
4901 LANG AVE NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87109-4495 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114920238 | Douglas A. Clark | Internal Medicine | 4901 Lang Ave Ne, Albuquerque, NM 87109-4397 | 2005-05-23 |
| 1194387555 | Courtney Marquez | Physician Assistant | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2019-07-05 |
| 1922570118 | Angerene Mitchell-matthews | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2018-12-28 |
| 1700362597 | Sandra Lee Rowe | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2018-07-14 |
| 1538612353 | Jennifer Vergeer | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109-4495 | 2016-07-28 |
| 1528418274 | Rachel S Camp | Physician Assistant | 4901 Lang Ave Ne, Suite 100, Albuquerque, NM 87109-4495 | 2016-06-14 |
| 1457707150 | Deborah Schwartz | Family Medicine | 4901 Lang Ave Ne, Albuquerque, NM 87109 | 2016-05-11 |
| 1407227002 | Truecare LLC | Family Medicine | 4901 Lang Ave Ne, Ste 202, Albuquerque, NM 87109-4495 | 2015-10-08 |
| 1174911093 | New Mexico Center for Minimally Invasive Therapies | Radiology | 4901 Lang Ave Ne, Suite 202, Albuquerque, NM 87109-4495 | 2014-12-30 |
| 1538566211 | Felicia R. Mazzei | Nurse Practitioner | 4901 Lang Ave Ne, Albuquerque, NM 87109 | 2014-11-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
| 1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
| 1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
| 1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
| 1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
| 1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
| 1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
| 1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
| 1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
| 1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
| Find all providers in zip 87109 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124658299 | City Mobile Ultrasound, LLC | Radiology | 524 Richmond Dr Se, Albuquerque, NM 87106-2328 | 2020-01-17 |
| 1013407964 | Erika Jane Starks | Radiology | Radiology Msc 10-5530 1 University of New Mexico, Albuquerque, NM 87131-5040 | 2018-05-16 |
| 1700229523 | Martha F Terrazas | Radiology | Msc 10 5530 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2013-04-11 |
| 1922341585 | Katherine Nicole Epstein | Radiology | Msc10 5530 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2013-04-02 |
| 1962745869 | Joshua Eric Rider | Radiology | Unmh, 2211 Lomas Blvd Ne, Albuquerque, NM 87106 | 2013-03-29 |
| 1346506904 | Andrew Bruner | Radiology | Msc 10-5550 1, University of New Mexico, Albuquerque, NM 87131 | 2012-04-09 |
| 1942576145 | Douglas James Alden | Radiology | 373 Big Horn Ridge Dr Ne, Albuquerque, NM 87122-1424 | 2012-04-02 |
| 1689947921 | Robert Johnson | Radiology | 804 Piedra Vista Rd Ne, Albuquerque, NM 87123-1954 | 2012-02-16 |
| 1386936623 | Matthew Stevens Myers | Radiology | Graduate Medical Education Msc 116093, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2011-05-04 |
| 1346530409 | Amirkasra Mojtahed | Radiology | 4352 Altura Mesa Ln Ne, Albuquerque, NM 87110-5059 | 2011-04-11 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87109 |
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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.