Provider Demographics
NPI:1508677550
Name:WILKES, DANITA R (CMA,CPT,CET)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:R
Last Name:WILKES
Suffix:
Gender:F
Credentials:CMA,CPT,CET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 SWANN RD APT 101
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1326
Mailing Address - Country:US
Mailing Address - Phone:443-490-9157
Mailing Address - Fax:
Practice Address - Street 1:10001 DEREKWOOD LN STE 204-135
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4804
Practice Address - Country:US
Practice Address - Phone:443-399-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24R-1831246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty