Provider Demographics
NPI:1124169149
Name:COATES-WILKES, CHARLOTTE E (M D)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:E
Last Name:COATES-WILKES
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 BELLONA LN
Mailing Address - Street 2:STE 102, RUXTON TOWERS
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2014
Mailing Address - Country:US
Mailing Address - Phone:410-828-5911
Mailing Address - Fax:410-828-0716
Practice Address - Street 1:8417 BELLONA LN
Practice Address - Street 2:STE 102, RUXTON TOWERS
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2014
Practice Address - Country:US
Practice Address - Phone:410-828-5911
Practice Address - Fax:410-828-0716
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00023322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D0002332OtherSTATE LICENSE
MDD77671Medicare UPIN