Provider Demographics
NPI:1104150838
Name:MCJILTON, LESLIE JUNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JUNE
Last Name:MCJILTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 RIDGELYS CHOICE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2953
Mailing Address - Country:US
Mailing Address - Phone:855-910-3278
Mailing Address - Fax:
Practice Address - Street 1:MEDSTAR URGENT CARE CLINIC
Practice Address - Street 2:8605 RIDGELYS CHOICE DR SUITE 100
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2953
Practice Address - Country:US
Practice Address - Phone:855-910-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006324363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0006324OtherMARYLAND STATE LICENSE