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General NPI Number Information
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NPI Number | 1407151632
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Entity Type | Individual
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Provider Name | ALICIA MICHELLE WIGGINS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1285 FULTON AVE
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City | BRONX
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State | NY
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Zip | 10456-3401
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Country | US
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Telephone | 716-857-0553
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Fax | 585-626-6061
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Provider Business Mailing Address
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Address Line | 4408 LOCUST POINT DR
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City | BRONX
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State | NY
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Zip | 10465-4038
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Country | US
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Telephone | 716-857-0553
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Fax | 585-626-6061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01071585A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2663701
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License Number State | NY
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