Provider Demographics
NPI:1104821396
Name:WILKENS, JAMES B JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:WILKENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1615
Mailing Address - Country:US
Mailing Address - Phone:814-827-9770
Mailing Address - Fax:814-827-0157
Practice Address - Street 1:322 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1615
Practice Address - Country:US
Practice Address - Phone:814-827-9770
Practice Address - Fax:814-827-0157
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043086E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011804220002Medicaid
PA010627Medicare ID - Type Unspecified