Individual
ELIZABETH COLLENS WICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 N WOLFE ST, BLALOCK 658, BALTIMORE, MD 21287-0005
(410) 955-7323
Mailing address
PO BOX 64563, BALTIMORE, MD 21264-4563
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A76824
CA
208600000X
Surgery Physician
Primary
D67913
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
415768100
—
MD
Enumeration date
03/02/2007
Last updated
02/20/2013
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