Provider Demographics
NPI:1023128931
Name:WICKER, DONNA C (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:C
Last Name:WICKER
Suffix:
Gender:F
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1460
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:4701 SPOTSYLVANIA PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-834-5420
Practice Address - Fax:540-834-5421
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043788207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00822131OtherMEDICARE RAILROAD
VA006209505Medicaid
VA540896390OtherCIGNA
E90543Medicare UPIN
VA160001458Medicare ID - Type Unspecified
VAP00822131OtherMEDICARE RAILROAD