Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101242318 | VA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 0101242318 | VA |
NPI | 1588652812 |
---|---|
Provider Name | Marc William Flickinger |
First Address | Baltimore, MD 21275-5268 |
Second Address | Charlottesville, VA 22911-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 23/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H37806 | (02) |