Provider Demographics
NPI:1902871379
Name:WILKINSON, EARL VANE III (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:VANE
Last Name:WILKINSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11122 PROUDFOOT PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1047
Mailing Address - Country:US
Mailing Address - Phone:410-992-1862
Mailing Address - Fax:
Practice Address - Street 1:5500 KNOLL NORTH DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-964-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027106207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD74480Medicare UPIN