=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578535647
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL CARLTON WILKENS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 06/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 CROSSROADS DR STE 100
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-356-8186
-----------------------------------------------------
Fax | 410-356-4180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7799 LEESBURG PIKE SUITE 1000 N
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22043-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-667-8600
-----------------------------------------------------
Fax | 703-667-8601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | D0055102
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------