Provider Demographics
NPI:1104997774
Name:TICKNOR, ARTHUR STERLING (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:STERLING
Last Name:TICKNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:160 MERCHANT ST STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-4772
Practice Address - Country:US
Practice Address - Phone:540-536-5560
Practice Address - Fax:540-536-5561
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104997774Medicaid
ORMD156166OtherLICENSE
NY10031992 0163OtherCDPHP
NY201501160OtherTAX ID NUMBER
NY205551OtherNYS STATE LICENSE
NY01871750Medicaid
NY201501160OtherTAX ID NUMBER