Provider Demographics
NPI:1699974097
Name:WILKINSON, JARED T (DPM)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:T
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2690
Mailing Address - Country:US
Mailing Address - Phone:207-725-4008
Mailing Address - Fax:207-725-5749
Practice Address - Street 1:81 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2100
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2690
Practice Address - Country:US
Practice Address - Phone:207-725-4008
Practice Address - Fax:207-725-5749
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD 1060213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435660599Medicaid
ME000151701Medicare UPIN
ME435660599Medicaid
ME0915250001Medicare NSC