Provider Demographics
NPI:1730125337
Name:WILKERSON, JOEL HARRISON (MD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:HARRISON
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-547-1225
Mailing Address - Fax:202-544-3805
Practice Address - Street 1:1130 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-547-1225
Practice Address - Fax:202-544-3805
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8855OtherBC BS
DC010070900Medicaid
DC8855OtherBC BS
C62759Medicare UPIN