Individual
DR. LOELLA E. CLARK WICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
130 CENTER WAY, CORNING, NY 14830-2255
(607) 936-9971
(607) 936-2600
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 882-3007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
173504-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011150680003
—
PA
05
—
01060824
—
NY
01
—
CC8362
RR MEDICARE GROUP
NY
Enumeration date
02/28/2006
Last updated
11/02/2007
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