Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 220715 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | D0063195 | MD |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | D0063195 | MD |
NPI | 1053311035 |
---|---|
Provider Name | Dr. Steven Wilks |
First Address | Baltimore, MD 21279-1372 |
Second Address | Bethesda, MD 20814-1422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 06/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003110100 | (05) | MD |
415096100 | (05) | MD |
I01305 | (02) | MD |
I01305 | (02) | NY |