Provider Demographics
NPI:1659310639
Name:VICK, RALPH NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:NELSON
Last Name:VICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6488
Mailing Address - Country:US
Mailing Address - Phone:704-248-3400
Mailing Address - Fax:704-337-8387
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:STE 5202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-547-1495
Practice Address - Fax:704-547-1861
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC800319OtherPARTNERS PROV #
NC89131HHMedicaid
NC131HHOtherBCBS NC INDIVIDUAL PROV#
NC2001083CMedicare PIN
NCH60961Medicare UPIN
NC89131HHMedicaid