Provider Demographics
NPI:1861678120
Name:DANIEL T SICKING MD PA
Entity Type:Organization
Organization Name:DANIEL T SICKING MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SICKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-562-4441
Mailing Address - Street 1:14341 NEW FALLS OF NEUSE STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8292
Mailing Address - Country:US
Mailing Address - Phone:919-562-4441
Mailing Address - Fax:919-562-5779
Practice Address - Street 1:14341 NEW FALLS OF NEUSE STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8292
Practice Address - Country:US
Practice Address - Phone:919-562-4441
Practice Address - Fax:919-562-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300396261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7976118Medicaid
NC7976118Medicaid
A80890Medicare UPIN