Provider Demographics
NPI:1780717314
Name:WILMES, DONALD B (PHD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:WILMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 40TH ST
Mailing Address - Street 2:SUITE 456A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2199
Mailing Address - Country:US
Mailing Address - Phone:410-467-1585
Mailing Address - Fax:410-235-9339
Practice Address - Street 1:711 W 40TH ST
Practice Address - Street 2:SUITE 456A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2199
Practice Address - Country:US
Practice Address - Phone:410-467-1585
Practice Address - Fax:410-235-9339
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD29664OtherHOPKINS EMPLOYEE HEALTH P
MDGL01DBOtherCARE 1ST BCBS