Healthcare Provider Details

I. General information

NPI: 1700070513
Provider Name (Legal Business Name): EARL V. WILKINSON, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 KNOLL NORTH DR SUITE 310
COLUMBIA MD
21045-2209
US

IV. Provider business mailing address

5500 KNOLL NORTH DR SUITE 310
COLUMBIA MD
21045-2209
US

V. Phone/Fax

Practice location:
  • Phone: 410-964-5226
  • Fax:
Mailing address:
  • Phone: 410-964-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0027106
License Number StateMD

VIII. Authorized Official

Name: DR. EARL VANE WILKINSON III
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 410-964-5226