MR. BOYD ROY WICKIZER JR. (NPI# 1750330353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750330353 |
| Entity Type | Individual |
| Full Name | MR. BOYD ROY WICKIZER JR. |
| Credential | M.D. |
| Practice Address |
200 Medical Park Blvd Petersburg VA 23805-9274 |
| Mailing Address |
Po Box 446 Midlothian VA 23113-0446 |
| Practice Telephone | 8047655949 |
| Practice Fax Number | 8047656250 |
| Mailing Telephone | 8048583998 |
| Mailing Fax Number | 8047656250 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2009-12-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 0101047692 | VA | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 0101047692 | VA | Allopathic & Osteopathic Physicians |
| Street Address |
200 MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413636 | Delesa Shana Kay Walden | Registered Nurse | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-09-27 |
| 1992339436 | Amy Kathryn Lansing | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-24 |
| 1588296453 | Erin Elise Layne | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-10 |
| 1295374643 | Crystal Leigh Maddox | Physical Therapist | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-01-02 |
| 1366081911 | Joshua Paul Pidcoe | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-12-31 |
| 1720623853 | Bon Secours Mercy Health Petersburg LLC | General Acute Care Hospital | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-11-13 |
| 1144874686 | Nina Thi Ong-pham | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-08-01 |
| 1720543507 | Martina Rochelle Washington | Specialist/Technologist, Other | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-02-05 |
| 1356812242 | Ams Virginia Pllc | Nurse Anesthetist, Certified Registered | 200 Medical Park Blvd, Petersburg, VA 23805 | 2018-12-17 |
| 1841761079 | Erin Collins | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114020351 | Emilie J Redding | Emergency Medicine | 14535 Boy Scout Trl, Petersburg, IL 62675-6230 | 2006-09-06 |
| 1104872019 | Mark Militana | Emergency Medicine | 804 South Adams Street, Petersburg, VA 23803 | 2006-05-25 |
| 1609856566 | Eniola Adebayo Okelana | Emergency Medicine | 433b S Sycamore St, Petersburg, VA 23803-5042 | 2006-01-18 |
| 1730565128 | Tri-county Emergency Physicians LLC | Emergency Medicine | 117 Hospital Dr, Petersburg, WV 26847-9566 | 2015-08-07 |
| 1447660410 | Freud Milice | Emergency Medicine | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2014-04-30 |
| 1093135196 | Michael W Cieslinski | Emergency Medicine | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2014-04-16 |
| 1528480712 | National Emergency Services West Virginia Inc | Emergency Medicine | 117 Hospital Dr, Petersburg, WV 26847-9566 | 2014-01-08 |
| 1659711455 | Matthew Shannon Johnson | Emergency Medicine | 117 Hospital Dr, Petersburg, WV 26847-9566 | 2013-06-26 |
| 1437412293 | Brendan D Mccay | Emergency Medicine | 200 Medical Park Blvd, Em: Emergency Medicine, Petersburg, VA 23805-9274 | 2012-06-18 |
| 1225398027 | Virginia Emergency Group, LLC | Emergency Medicine | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2012-05-25 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| 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.