Healthcare Provider Details

I. General information

NPI: 1891879508
Provider Name (Legal Business Name): CAROL JAMES WILKERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

8419 SULKY CT
ALEXANDRIA VA
22308-2254
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-8196
  • Fax: 202-483-0836
Mailing address:
  • Phone: 703-619-0577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD035240
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: