# ST. CLEMENTS INTERNAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. CLEMENTS MEDICAL CARE, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1306086848
- **Legal business name:** ST. CLEMENTS MEDICAL CARE, LLC
- **Authorized official:** DR. THOMAS M WILKINSON M.D. (OWNER/OFFICER)
- **Authorized official phone:** (301) 997-0611

## Contact information

- **Practice address:** 23130 MOAKLEY ST, LEONARDTOWN, MD 20650-2918
- **Practice address phone:** (301) 997-1313
- **Practice address fax:** (301) 997-0709
- **Mailing address:** 40900 MERCHANTS LN, SUITE 207, LEONARDTOWN, MD 20650-3700
- **Mailing address phone:** (301) 997-1580
- **Mailing address fax:** (301) 997-0709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R063357 | MD | Yes |

## Other

- **Enumeration date:** 02/24/2009
- **Last updated:** 02/24/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 143000900 | — | MD |