Provider Demographics
NPI:1891717948
Name:DICKMAN, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DICKMAN
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 1:310 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571
Mailing Address - Country:US
Mailing Address - Phone:919-438-3937
Mailing Address - Fax:919-435-6792
Practice Address - Street 1:310 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571
Practice Address - Country:US
Practice Address - Phone:919-438-3937
Practice Address - Fax:919-435-6792
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA2508114400207W00000X
NC200901699207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology