Provider Demographics
NPI:1427182930
Name:STEPHEN V. WILKINSON, DPM, LLC
Entity Type:Organization
Organization Name:STEPHEN V. WILKINSON, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-228-2305
Mailing Address - Street 1:300 AURORA ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2410
Mailing Address - Country:US
Mailing Address - Phone:410-228-2305
Mailing Address - Fax:410-228-8521
Practice Address - Street 1:300 AURORA ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2410
Practice Address - Country:US
Practice Address - Phone:410-228-2305
Practice Address - Fax:410-228-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01224213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5010460001Medicare NSC
MD142PMedicare PIN