MEDICARE: MARK MCVICKER CPO

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	224P00000X	Prosthetist	CPO 02017	MD

General Provider Information

NPI Number	:	1528148533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MCVICKER CPO

Provider Business Mailing Address
First Line	:	2421 LINDEN LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1230
Country	:	US
Telephone Number	:	301-585-5347
Fax Number	:	301-585-4383

Provider Business Practice Location Address
First Line	:	2421 LINDEN LN
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-1230
Country	:	US
Telephone Number	:	301-585-5347
Fax Number	:	301-585-4383

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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