Provider Demographics
NPI:1578535647
Name:WILKENS, JILL CARLTON (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CARLTON
Last Name:WILKENS
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 1:7799 LEESBURG PIKE
Mailing Address - Street 2:SUITE 1000 N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2408
Mailing Address - Country:US
Mailing Address - Phone:703-667-8600
Mailing Address - Fax:703-667-8601
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:STE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-356-8186
Practice Address - Fax:410-356-4180
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00551022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ062OtherB/C B/S
DC2849OtherB/C B/S
MD536500700Medicaid
MDKA80OtherB/C B/S
MDKA80OtherB/C B/S
MD434L302YMedicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MD575P180HMedicare PIN
MDG94236Medicare UPIN
DEDD4343Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDCN2566Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDJ062OtherB/C B/S