Provider Demographics
NPI:1275589590
Name:CHARLES E WILKINSJR MD PA
Entity Type:Organization
Organization Name:CHARLES E WILKINSJR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-784-1111
Mailing Address - Street 1:146 HADDONFIELD BERLIN RD S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1018
Mailing Address - Country:US
Mailing Address - Phone:856-784-1111
Mailing Address - Fax:856-435-4070
Practice Address - Street 1:146 HADDONFIELD BERLIN RD S
Practice Address - Street 2:SUITE 301
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1018
Practice Address - Country:US
Practice Address - Phone:856-784-1111
Practice Address - Fax:856-435-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA21045207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2835100Medicare ID - Type Unspecified
NJD18563Medicare UPIN