Provider Demographics
NPI:1447229810
Name:DICKMAN, AUBREY (MD)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:DICKMAN
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 1:3 WOODLAND RD
Mailing Address - Street 2:SUITE 421
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1702
Mailing Address - Country:US
Mailing Address - Phone:781-665-2525
Mailing Address - Fax:781-665-1207
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:SUITE 421
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-665-2525
Practice Address - Fax:781-665-1207
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50391207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ0465601OtherMEDICARE FOR CAMBRIDGE HEALTH ALLIANCE
MA6199275Medicaid
MAA57965Medicare UPIN
MAJ0465601OtherMEDICARE FOR CAMBRIDGE HEALTH ALLIANCE