Provider Demographics
NPI:1386024875
Name:WILKINSON, CHARLES EVANS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EVANS
Last Name:WILKINSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5360 TWIN HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5682
Mailing Address - Country:US
Mailing Address - Phone:804-346-3200
Mailing Address - Fax:804-346-4075
Practice Address - Street 1:2500 POCOSHOCK PL STE 104
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-276-9305
Practice Address - Fax:804-674-4145
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2018-08-13
Deactivation Date:2018-07-09
Deactivation Code:
Reactivation Date:2018-08-10
Provider Licenses
StateLicense IDTaxonomies
VA0101263619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine