MEDICARE: PATRICIA A DICKERSON MD

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	207N00000X	Dermatology Physician	350554000	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336132950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A DICKERSON MD

Provider Business Mailing Address
First Line	:	1299 E ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2658
Country	:	US
Telephone Number	:	937-436-1117
Fax Number	:	937-436-9576

Provider Business Practice Location Address
First Line	:	1299 E ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2658
Country	:	US
Telephone Number	:	937-436-1117
Fax Number	:	937-436-9576

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	11/05/2012

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Practice Location Address:

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1215041041 — PATRICIA A. DICKERSON MD
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1497906234 — SARAH A BALLARD PA-C
Practice Location Address:

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CENTERVILLE, OH
45459-2658

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1750525473 — MS. EMILY SUZANNE MONROE PA-C
Practice Location Address:

1299 E ALEX BELL RD
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1962795302 — DERMATOLOGY & AESTHETIC CARE LLC
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1265866362 — MS. AMY M BUSCHUR FNP
Practice Location Address:

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45459-2658

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Directions to “ PATRICIA A DICKERSON MD” Practice Location

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