MEDICARE: DR. DAMIAN DYCKMAN M.D., PH.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	208D00000X	General Practice Physician	0101248114	VA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2085R0202X	Diagnostic Radiology Physician	92181	GA

General Provider Information

NPI Number	:	1952538381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIAN DYCKMAN M.D., PH.D.

Provider Business Mailing Address
First Line	:	NBHC MIRAMAR
Second Line	:	BLDG 2496 BAUER RD
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NBHC MIRAMAR
Second Line	:	BLDG 2496 BAUER RD
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:	858-577-9944
Fax Number	:

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

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	07/26/2022

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