Provider Demographics
NPI:1801849724
Name:BICKEL, RUDOLF G (MD)
Entity Type:Individual
Prefix:
First Name:RUDOLF
Middle Name:G
Last Name:BICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 HAGEN WAY
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3199
Mailing Address - Country:US
Mailing Address - Phone:703-754-7652
Mailing Address - Fax:
Practice Address - Street 1:15508 HAGEN WAY
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-3199
Practice Address - Country:US
Practice Address - Phone:703-754-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005600065Medicaid
VA113812OtherBCBS
VA080006483Medicare PIN
VA113812OtherBCBS