MEDICARE: MARK R WICK

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	0101221389	VA

General Provider Information

NPI Number	:	1568531101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK R WICK

Provider Business Mailing Address
First Line	:	500 RAY C HUNT DR
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-2981
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LEE ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0001
Country	:	US
Telephone Number	:	434-924-0000
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/07/2025

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