Provider Demographics
NPI:1114917291
Name:WILKES, DAWN'C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN'C
Middle Name:
Last Name:WILKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0907
Mailing Address - Country:US
Mailing Address - Phone:215-453-4995
Mailing Address - Fax:215-453-4646
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-453-3360
Practice Address - Fax:215-453-3366
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055317L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5518242OtherAETNA
PA0015096610007Medicaid
0787947000OtherIBC
675423OtherHIGHMARK BLUE SHIELD
0787947000OtherIBC
675423OtherHIGHMARK BLUE SHIELD