Provider Demographics
NPI:1689696593
Name:WILKENFELD, MORRIS JACK (MD)
Entity Type:Individual
Prefix:MR
First Name:MORRIS
Middle Name:JACK
Last Name:WILKENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:JACK
Other - Last Name:WILKENFELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10004 FOX SPRING CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2657
Mailing Address - Country:US
Mailing Address - Phone:703-626-0776
Mailing Address - Fax:
Practice Address - Street 1:10004 FOX SPRING CT
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2657
Practice Address - Country:US
Practice Address - Phone:703-626-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031061207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010169844Medicaid
VA4284210OtherAETNA
VA006135OtherANTHEM
D09418Medicare UPIN
167917Medicare PIN
VAG01896Medicare ID - Type Unspecified