MEDICARE: DR. WILKINSON JESUDAS NINALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0045285	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760542740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILKINSON JESUDAS NINALA MD

Provider Business Mailing Address
First Line	:	831 UNIVERSITY BLVD E STE 37
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2915
Country	:	US
Telephone Number	:	301-328-7155
Fax Number	:	301-328-7182

Provider Business Practice Location Address
First Line	:	831 UNIVERSITY BLVD E STE 37
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2915
Country	:	US
Telephone Number	:	301-328-7155
Fax Number	:	301-328-7182

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	12/10/2021

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