Provider Demographics
NPI:1326001611
Name:DICKINSON, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:DICKINSON
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 1:567 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6126
Mailing Address - Country:US
Mailing Address - Phone:828-234-4949
Mailing Address - Fax:
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-327-9178
Practice Address - Fax:828-304-0202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20538208600000X, 2086S0129X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928487Medicaid
NC657764OtherFIRST HEALTH
NC279897OtherMAMSI
NC28487OtherBLUE CROSS BLUE SHIELD NC
NCA8808OtherMEDCOST
NC9832OtherPARTNERS
NCA8808OtherMEDCOST
NC9832OtherPARTNERS