Individual
DR. MICHAEL M DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 GARFIELD AVE, HEALING CENTER AT CCMH, PARKERSBURG, WV 26101-5340
(304) 424-2228
(304) 420-7128
Mailing address
1602 GREENMONT HILLS DR, VIENNA, WV 26105-3292
(304) 424-2228
(304) 420-7128
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
200001115
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127TY
BCBS OF NC GROUP #015CK
NC
05
—
89127TY
—
NC
01
—
D0709
MEDCOST #
NC
Enumeration date
07/20/2005
Last updated
07/20/2010
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