Provider Demographics
NPI:1891701694
Name:WHICKER, LAWRENCE R (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:WHICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7500 HANOVER PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2009
Mailing Address - Country:US
Mailing Address - Phone:301-982-5008
Mailing Address - Fax:301-441-8696
Practice Address - Street 1:7500 HANOVER PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2009
Practice Address - Country:US
Practice Address - Phone:301-982-5008
Practice Address - Fax:301-441-8696
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD379792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0500142OtherUNITED HEALTHCARE
DC16540007OtherCAREFIRST BCBS
MD528559OtherAETNA USHC
MD52544002OtherCAREFIRST BCBS
MD20164OtherMAMSI
MD912931600Medicaid
MD190862N67Medicare PIN
MD20164OtherMAMSI