Provider Demographics
NPI:1487974994
Name:WILKINSON, LEE A (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N 7TH ST
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1720
Mailing Address - Country:US
Mailing Address - Phone:717-267-7973
Mailing Address - Fax:
Practice Address - Street 1:112 N 7TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7973
Practice Address - Fax:717-267-7127
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196749207ZC0500X, 207ZP0102X
PAMD450956207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103020556 0001Medicaid
PA103020556 0001Medicaid