# ST. CLEMENTS MEDICAL CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982680641
- **Authorized official:** THOMAS MCCALL WILKINSON MD (OWNER)
- **Authorized official phone:** (301) 997-0611

## Contact information

- **Practice address:** 23130 MOAKLEY ST, LEONARDTOWN, MD 20650-2918
- **Practice address phone:** (301) 997-0611
- **Practice address fax:** (301) 997-0709
- **Mailing address:** 23130 MOAKLEY ST, LEONARDTOWN, MD 20650-2918
- **Mailing address phone:** (301) 997-0611
- **Mailing address fax:** (301) 997-0709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D0047849 | MD | Yes |
| 207Q00000X | Family Medicine Physician | D0055682 | MD | — |
| 207Q00000X | Family Medicine Physician | D0059422 | MD | — |
| 363AM0700X | Medical Physician Assistant | PA59937 | MD | — |
| 363AM0700X | Medical Physician Assistant | PA66598 | MD | — |

## Other

- **Enumeration date:** 12/15/2005
- **Last updated:** 03/12/2009