Basic Information
| Provider Information | |||||||||
| NPI: | 1053311035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILKS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 791372 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212791372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016088375 | ||||||||
| FaxNumber: | 3016083979 | ||||||||
| Practice Location | |||||||||
| Address1: | 8600 OLD GEORGETOWN RD | ||||||||
| Address2: | ATTN: MEDICAL STAFF OFFICE/ANGELA SPECK | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208141422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018963100 | ||||||||
| FaxNumber: | 3018971378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 07/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 220715 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QA0505X | D0063195 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QH0002X | D0063195 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 003110100 | 05 | MD | MEDICAID | 415096100 | 05 | MD | MEDICAID |