Provider Demographics
NPI:1043299852
Name:FICKE, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:FICKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N CAROLINE ST
Mailing Address - Street 2:JHOC 5215
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21278-0006
Mailing Address - Country:US
Mailing Address - Phone:410-502-1714
Mailing Address - Fax:
Practice Address - Street 1:601 N CAROLINE ST
Practice Address - Street 2:JHOC 5215
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21278-0006
Practice Address - Country:US
Practice Address - Phone:410-502-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8747207XX0004X
MDD76759207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK8747OtherPHYSICIAN LICENSE
MDD0076769OtherMARYLAND LICENSE