Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 19553 | NH |
N | 207X00000X | Orthopaedic Surgeon | 4301103221 | MI |
N | 207X00000X | Orthopaedic Surgeon | D85867 | MD |
N | 207XS0117X | Orthopaedic Spine Surgeon | 19553 | NH |
NPI | 1295174753 |
---|---|
Provider Name | Matthew Walter Wilkening |
First Address | Nashua, NH 03062-1383 |
Second Address | Nashua, NH 03062-1383 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 02/10/2019 |