Provider Demographics
NPI:1528148533
Name:MCVICKER, MARK (CPO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCVICKER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1230
Mailing Address - Country:US
Mailing Address - Phone:301-585-5347
Mailing Address - Fax:301-585-4383
Practice Address - Street 1:2421 LINDEN LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1230
Practice Address - Country:US
Practice Address - Phone:301-585-5347
Practice Address - Fax:301-585-4383
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCPO 02017224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist