Healthcare Provider Details

I. General information

NPI: 1306429873
Provider Name (Legal Business Name): ALTHEA LAUREN BICKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALTHEA LAUREN PORTER

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 HEATHERSTONE DR
FREDERICKSBURG VA
22407-4828
US

IV. Provider business mailing address

1123 HEATHERSTONE DR
FREDERICKSBURG VA
22407-4828
US

V. Phone/Fax

Practice location:
  • Phone: 540-899-2555
  • Fax:
Mailing address:
  • Phone: 540-899-2555
  • Fax: 540-899-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101283010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: