Healthcare Provider Details

I. General information

NPI: 1295733244
Provider Name (Legal Business Name): CHARLES A WILKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 KEMPSVILLE RD STE 208
NORFOLK VA
23502-3927
US

IV. Provider business mailing address

844 KEMPSVILLE RD STE 208
NORFOLK VA
23502-3927
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-3890
  • Fax: 757-461-0836
Mailing address:
  • Phone: 757-461-3890
  • Fax: 757-461-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101033142
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: