Provider Demographics
NPI:1790720845
Name:SCHICKER, LINDA LAUREE' (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LAUREE'
Last Name:SCHICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E. CHESTNUT ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-338-0897
Mailing Address - Fax:315-336-6375
Practice Address - Street 1:107 E CHESTNUT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2834
Practice Address - Country:US
Practice Address - Phone:315-338-0897
Practice Address - Fax:315-336-6375
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1992562085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY107863235Medicaid
NYG0181298330OtherEXCELLUS
NY395550OtherMVP
NY56745BMedicare ID - Type Unspecified
NY107863235Medicaid