Provider Demographics
NPI:1548233703
Name:WICKER, HENRY S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:WICKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1460
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:4701 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9435
Practice Address - Country:US
Practice Address - Phone:540-834-5450
Practice Address - Fax:540-834-5451
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044445208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137724OtherANTHEM
VA007306172Medicaid
VA4235093OtherAETNA NON HMO
VA425273OtherMAMSI
VA0898260OtherAETNA HMO
VAC02375OtherMEDICARE GROUP
VACA9037OtherMCR RAILROAD GROUP
VA0101044445OtherLICENSE
VA0898260OtherAETNA HMO
VACA9037OtherMCR RAILROAD GROUP
VA425273OtherMAMSI