Provider Demographics
NPI:1932282811
Name:SICA, DOMENIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:A
Last Name:SICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOMENIC
Other - Middle Name:ANGELO
Other - Last Name:SICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1745
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:828-655-3804
Practice Address - Fax:828-571-7804
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027527207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6000118Medicaid
B06858Medicare UPIN
390000001Medicare ID - Type Unspecified