Provider Demographics
NPI:1811918980
Name:DICKINSON, ADA BARBARA (MD)
Entity type:Individual
Prefix:DR
First Name:ADA
Middle Name:BARBARA
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3174
Mailing Address - Country:US
Mailing Address - Phone:704-752-2000
Mailing Address - Fax:704-752-1212
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3174
Practice Address - Country:US
Practice Address - Phone:704-752-2000
Practice Address - Fax:704-752-1212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC93-00080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928729Medicaid
NCF04972Medicare UPIN