Provider Demographics
NPI:1043250111
Name:DICKERSON, JANICE F (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:F
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:FISHER
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-686-2525
Mailing Address - Fax:910-686-1606
Practice Address - Street 1:7420 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9453
Practice Address - Country:US
Practice Address - Phone:910-686-2525
Practice Address - Fax:910-686-1606
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043250111Medicaid
NC8911486Medicaid
NC2257778BMedicare PIN
NC2257778FMedicare PIN
NC1043250111Medicaid
NC1022110001Medicare NSC
G77928Medicare UPIN
NC080158277Medicare PIN
NC8911486Medicaid