Organization
ST. CLEMENTS MEDICAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MCCALL WILKINSON MD (OWNER)
(301) 997-0611
Entity
Organization
Contact information
Practice address
23130 MOAKLEY ST, LEONARDTOWN, MD 20650-2918
(301) 997-0611
(301) 997-0709
Mailing address
23130 MOAKLEY ST, LEONARDTOWN, MD 20650-2918
(301) 997-0611
(301) 997-0709
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0047849
MD
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
511108100
—
MD
Enumeration date
12/15/2005
Last updated
03/12/2009
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