Provider Demographics
NPI:1760507420
Name:WILKING MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:WILKING MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:VAN B
Authorized Official - Last Name:WILKING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-6064
Mailing Address - Street 1:35 ROBIN WOOD RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3914
Mailing Address - Country:US
Mailing Address - Phone:978-369-6064
Mailing Address - Fax:978-369-0352
Practice Address - Street 1:35 ROBIN WOOD RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3914
Practice Address - Country:US
Practice Address - Phone:978-369-6064
Practice Address - Fax:978-369-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9780475Medicaid
MAM20289Medicare ID - Type Unspecified