MEDICARE: DR. REBECCA F VICKERS 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	208000000X	Pediatrics Physician	D52383	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7325284	OTHER	AETNA
3	54698208	OTHER	BCBS MD
4	38940001	OTHER	BCBS DC
5	54698209	OTHER	BCBS MD

General Provider Information

NPI Number	:	1588643589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA F VICKERS MD

Provider Business Mailing Address
First Line	:	1460 RITCHIE HWY STE 209
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2741
Country	:	US
Telephone Number	:	410-789-7337
Fax Number	:	410-349-1107

Provider Business Practice Location Address
First Line	:	1460 RITCHIE HWY STE 209
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2741
Country	:	US
Telephone Number	:	410-789-7337
Fax Number	:	410-349-1107

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	06/04/2024

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