MEDICARE: CRAIG M WILKERSON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1124659362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG M WILKERSON

Provider Business Mailing Address
First Line	:	12219 SWEETWOOD PL
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-1435
Country	:	US
Telephone Number	:	202-812-7484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 GALLATIN ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6918
Country	:	US
Telephone Number	:	202-812-7484
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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