Provider Demographics
NPI:1730248634
Name:VICK, SARAH NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:NICOLE
Last Name:VICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 JACOBSTOWN COOKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08562-1608
Mailing Address - Country:US
Mailing Address - Phone:202-550-2963
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:202-550-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061782A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine