Provider Demographics
NPI:1669459970
Name:WICKLINE, ANDREW B (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:WICKLINE
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:4401 MIDDLE SETTLEMENT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5331
Mailing Address - Country:US
Mailing Address - Phone:315-735-4496
Mailing Address - Fax:315-735-7066
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5331
Practice Address - Country:US
Practice Address - Phone:315-735-4496
Practice Address - Fax:315-735-7066
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2019-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY211832207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02237869Medicaid
NY02237869Medicaid