Provider Demographics
NPI:1346218385
Name:SICKING, DANIEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:SICKING
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 1:2109 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5099
Mailing Address - Country:US
Mailing Address - Phone:919-562-4441
Mailing Address - Fax:919-562-5779
Practice Address - Street 1:2109 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5099
Practice Address - Country:US
Practice Address - Phone:919-562-4441
Practice Address - Fax:919-562-5779
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7976118Medicaid
NC7976118Medicaid