Provider Demographics
NPI:1477586816
Name:WILKINSON, CHARLES P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:PATTON
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:SUITE 505
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:443-849-2196
Practice Address - Fax:443-849-2648
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD09821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD712L8765YBGOtherMEDICARE PIN
MDKJ54GB-52570101OtherCAREFIRST OF MARYLAND GBM
MDS1410002OtherCAREFIRST REGIONAL GBMC
MD755691800Medicaid
MDKJ54GB-52570101OtherCAREFIRST OF MARYLAND GBM
MD712L8765YBGOtherMEDICARE PIN
MDS1410002OtherCAREFIRST REGIONAL GBMC