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Organization

ST. CLEMENTS INTERNAL MEDICINE

Active
Parent organization
ST. CLEMENTS MEDICAL CARE, LLC
Organization subpart
Yes

Provider details

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

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R063357
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
143000900
MD
Enumeration date
02/24/2009
Last updated
02/24/2009
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