Healthcare Provider Details

I. General information

NPI: 1134396187
Provider Name (Legal Business Name): BEN ALAN FICKENSCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 07/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N EMERGENCY DEPARTMENT
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

109 G GAINSBOROUGH SQUARE BOX 723
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-6200
  • Fax: 757-312-6181
Mailing address:
  • Phone: 757-490-9388
  • Fax: 757-490-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101243627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: