1114917291 NPI number — DR. DAWN'C WILKES MD

Table of content: DR. DAWN'C WILKES MD (NPI 1114917291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114917291 NPI number — DR. DAWN'C WILKES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKES
Provider First Name:
DAWN'C
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114917291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLEYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19438-0907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-453-4995
Provider Business Mailing Address Fax Number:
215-453-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 LAWN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SELLERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18960-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-453-3360
Provider Business Practice Location Address Fax Number:
215-453-3366
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD055317L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5518242 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015096610007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0787947000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 675423 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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