Individual
DR. ALEXIS INEZ WICKERSHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
833 CHESTNUT ST, SUITE 701, PHILADELPHIA, PA 19107-4414
(215) 955-6180
(215) 955-6410
Mailing address
833 CHESTNUT ST, SUITE 701, PHILADELPHIA, PA 19107-4414
(215) 955-6180
(215) 955-6410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD-41908
IA
207R00000X
Internal Medicine Physician
Primary
MD457296
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103116559 0001
—
PA
Enumeration date
04/25/2012
Last updated
09/08/2016
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