MEDICARE: EDMUND WILKINSON D.O.

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	25MB06332800	NJ

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	:	1912987389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND WILKINSON D.O.

Provider Business Mailing Address
First Line	:	107 E MANTUA AVE
Second Line	:
City	:	WENONAH
State	:	NJ
Zip	:	08090-1950
Country	:	US
Telephone Number	:	856-468-6868
Fax Number	:	856-464-1855

Provider Business Practice Location Address
First Line	:	107 E MANTUA AVE
Second Line	:
City	:	WENONAH
State	:	NJ
Zip	:	08090-1950
Country	:	US
Telephone Number	:	856-468-6868
Fax Number	:	856-464-1855

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	11/02/2009

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