Provider Demographics
NPI:1043287774
Name:E BROOKS WILKINS FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:E BROOKS WILKINS FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:WHITAKER
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MED RN CDE
Authorized Official - Phone:919-571-6465
Mailing Address - Street 1:4020 WAKE FOREST RD
Mailing Address - Street 2:STE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6866
Mailing Address - Country:US
Mailing Address - Phone:919-571-6465
Mailing Address - Fax:919-571-6455
Practice Address - Street 1:4020 WAKE FOREST RD
Practice Address - Street 2:STE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6866
Practice Address - Country:US
Practice Address - Phone:919-571-6465
Practice Address - Fax:919-571-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2327701Medicare PIN