Provider Demographics
NPI:1205138906
Name:JOEL H. WILKERSON MD AND ASSOCIATES LLC
Entity type:Organization
Organization Name:JOEL H. WILKERSON MD AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-547-1225
Mailing Address - Street 1:204 MEDICAL CENTER RD.
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638
Mailing Address - Country:US
Mailing Address - Phone:410-827-7117
Mailing Address - Fax:410-827-9030
Practice Address - Street 1:204 MEDICAL CENTER RD.
Practice Address - Street 2:
Practice Address - City:GRASONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21638
Practice Address - Country:US
Practice Address - Phone:410-827-7117
Practice Address - Fax:410-827-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty