MEDICARE: DR. ROBERT DICKERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	151361	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326070590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DICKERSON M.D.

Provider Business Mailing Address
First Line	:	33 E. 125TH ST.
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027
Country	:	US
Telephone Number	:	212-879-5168
Fax Number	:	212-879-5168

Provider Business Practice Location Address
First Line	:	324 E 112
Second Line	:	6B
City	:	NEW YORK CITY
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-879-5168
Fax Number	:	212-879-5168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/10/2014

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