Basic Information
| Provider Information | |||||||||
| NPI: | 1073516043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKINSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 S ROSEMONT RD | ||||||||
| Address2: | STE 215 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234524336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574319551 | ||||||||
| FaxNumber: | 7574319663 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 S ROSEMONT RD | ||||||||
| Address2: | STE 215 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234524336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574319551 | ||||||||
| FaxNumber: | 7574319663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101051437 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 055108 | 01 | VA | ANTHEM OF VIRGINIA | OTHER | 890659I | 05 | NC | MEDICAID | 98120 | 01 | VA | OPTIMA SENTARA | OTHER | 0659I | 01 | NC | BC BS OF NORTH CAROLINA | OTHER |