Provider Demographics
NPI:1588643589
Name:VICKERS, REBECCA F (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:F
Last Name:VICKERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1460 RITCHIE HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2741
Mailing Address - Country:US
Mailing Address - Phone:410-789-7337
Mailing Address - Fax:410-349-1107
Practice Address - Street 1:1460 RITCHIE HWY STE 209
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2741
Practice Address - Country:US
Practice Address - Phone:410-789-7337
Practice Address - Fax:410-789-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
7325284OtherAETNA
MD255400300Medicaid
54698208OtherBCBS MD
38940001OtherBCBS DC
54698209OtherBCBS MD
38940001OtherBCBS DC