MEDICARE: DR. HENRY S WICKER JR. 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	208600000X	Surgery Physician	0101044445	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	C02375	OTHER	VA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	137724	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4235093	OTHER	VA	AETNA NON HMO
4	425273	OTHER	VA	MAMSI
5	0898260	OTHER	VA	AETNA HMO
7	CA9037	OTHER	VA	MCR RAILROAD GROUP
8	0101044445	OTHER	VA	LICENSE

General Provider Information

NPI Number	:	1548233703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY S WICKER JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1460
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22402-1460
Country	:	US
Telephone Number	:	540-786-2100
Fax Number	:	540-786-0677

Provider Business Practice Location Address
First Line	:	4701 SPOTSYLVANIA PKWY
Second Line	:	SUITE 203
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9435
Country	:	US
Telephone Number	:	540-834-5450
Fax Number	:	540-834-5451

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/10/2022

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Directions to “ DR. HENRY S WICKER JR. M.D.” Practice Location

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