Provider Demographics
NPI:1265424147
Name:BICKSEL, JAMES L (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:BICKSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-260-6650
Mailing Address - Fax:703-229-0367
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 514
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-260-6650
Practice Address - Fax:703-229-0367
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0365802084N0400X
VA01012360252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010155657Medicaid
VAI16775Medicare UPIN
VA010155657Medicaid