Basic Information
Provider Information
NPI: 1942786892
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILKINS
FirstName: JOSHUA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 304 N WATER ST
Address2:  
City: LANCASTER
State: PA
PostalCode: 176033374
CountryCode: US
TelephoneNumber: 7172996372
FaxNumber: 7179451587
Practice Location
Address1: 625 S DUKE ST
Address2:  
City: LANCASTER
State: PA
PostalCode: 176024509
CountryCode: US
TelephoneNumber: 7172996371
FaxNumber: 7179451587
Other Information
ProviderEnumerationDate: 07/13/2018
LastUpdateDate: 10/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA060107PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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