DR. MARIA REGINA LANDICHO WICKS (NPI# 1316025356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316025356 |
| Entity Type | Individual |
| Full Name | DR. MARIA REGINA LANDICHO WICKS |
| Other Name | DR. GINA LANDICHO WICKS |
| Credential | M.D. |
| Practice Address |
1722 Tagaytay Drive Fort Bragg NC 28310-0901 |
| Mailing Address |
145 Globemaster Ave Fort Bragg NC 28307-1569 |
| Practice Telephone | 9109077020 |
| Mailing Telephone | 4252744963 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 00023369 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WA MD LICENSE | 00023369 | 01 |
| WA | LABOR AND INDUSTRIES ID | 170322 | 01 |
| WA | DSHS (PAYABLE GROUP) | 7116841 | 01 |
| WA | 8176398 | 05 | |
| WA | MEDICARE UPIN | E47294 | 01 |
| WA | MEDICARE PIN (PTAN) | GAB38763 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 16701 Cleveland St, Suite 210, Redmond, WA 980520901 | 4258838050 | 4258852058 |
| Street Address |
1722 TAGAYTAY DRIVE |
| City | FORT BRAGG |
| State | NC |
| Zip Code | 28310-0901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013550763 | Brent Francis Bachman | Physician Assistant | 2817 Reilly Street, Fort Bragg, NC 28310 | 2019-10-25 |
| 1417503459 | Cooper Pasque | Dentist | 1838 Normandy Dr., Fort Bragg, Apo, AA 28310 | 2019-08-15 |
| 1851959951 | Daniel Jordan Whitaker | Student in an Organized Health Care Education/Training Program | Womack Army Medical Center, 2817 Reilly Road, Mcxc-cod Credentials, Fort Bragg, NC 28310 | 2019-06-03 |
| 1679054217 | Christopher Cetnar | Dentist | Smokebomb Hill, Bldg 3718 Gruber Road, Fort Bragg, NC 28310 | 2018-08-22 |
| 1316427107 | Alexandrea Lee Clark | Dentist | Laflamme Dental Clinic, Bldg C6238 Ardennes Road, Fort Bragg, NC 28310 | 2018-08-21 |
| 1457843831 | Kevin Patrick Hudson | Student in an Organized Health Care Education/Training Program | 2817 Reilly Road Mxcx - Cod Credentials, Womack Army Medical Center, Fort Bragg, NC 28310 | 2018-06-01 |
| 1639691462 | Margaret S Greene | Dentist | Usa Dental Health Activity Fort Bragg, Wamc Box #151 2817 Rielly Rd, Fort Bragg, NC 28310 | 2017-07-13 |
| 1912432246 | Chezdan Baker | Student in an Organized Health Care Education/Training Program | Us Army Dental Health Activity Bldg-6837 Normandy Drive, Fort Bragg, NC 28310 | 2017-04-24 |
| 1215483094 | Shantryce Monique Boatwright Crump | Dental Hygienist | 2617 Rielly Road, Fort Bragg, NC 28310 | 2016-08-31 |
| 1629435714 | John Gagnier | Physician Assistant | Gruber Road, Building #c-1722, Fort Bragg, NC 28310 | 2016-01-21 |
| Find all providers in zip 28310 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497001788 | Benjamin Charles Roberts | Family Medicine | 4861 Logistics St, 82 Cab Aeromedical Clinic, Fort Bragg, NC 28310-0001 | 2012-07-24 |
| 1598010571 | Ashley Alexandra Roselle | Family Medicine | Womack Medical Army Medical Center 2817 Reilly Road, Family Medicine Residency Clinic, Fort Bragg, NC 28310 | 2012-07-17 |
| 1912261033 | Robert Alan Powell | Family Medicine | Womack Army Medical, 2817 Reilly Road, Fort Bragg, NC 28310-0001 | 2012-07-03 |
| 1831486869 | Christopher Benjamin Brooks | Family Medicine | Womack Army Medical Center 2817 Reilly St, Family Medicine Clinic, Fort Bragg, NC 28310-7324 | 2011-06-28 |
| 1669684239 | Alan Wayne Davis | Family Medicine | A Co Swmg A, Fort Bragg, NC 28310-0001 | 2007-05-04 |
| 1962548040 | Amy Y Bogiel | Family Medicine | 2929 Desert Storm Dr, Usasoac Surgeon, Fort Bragg, NC 28310-9114 | 2007-01-29 |
| 1396851440 | Sanford Jay Brown | Family Medicine | 815b Sequoia Circle, Fort Bragg, CA 95437 | 2006-08-22 |
| 1386656312 | Diane I. Harris | Family Medicine | 850 Sequoia Cir, Fort Bragg, CA 95437-5490 | 2006-08-11 |
| 1629029202 | Mary V. Krueger | Family Medicine | Womack Family Medicine Residency, Building 4-2817 Reilly Road, Fort Bragg, NC 28310-0001 | 2006-05-16 |
| 1659331890 | Angela Hager Bailey | Family Medicine | Bldg 5-4257, Bastogne Ext, Fort Bragg, NC 28310-0001 | 2006-03-23 |
| Find all providers in FORT BRAGG | ||||
| City | FORT BRAGG |
| Zip Code | 28310 |
Please comment or provide details below to improve the information on DR. MARIA REGINA LANDICHO WICKS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.