Maurice McCall Vick Jr., MD

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

009957 Issued in LA

Practice address

5225 Odonovan
Ste 102
Baton Rouge, LA 70808-7202

Phone

(225) 767-2686

Fax

(225) 767-2687

NPI assigned

Sep 4, 2009

Last updated

Sep 4, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 5, 2015 through Nov 5, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252022400000",
    "number": "1871726000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 ODONOVAN",
            "address_2": "STE 102",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708087202",
            "telephone_number": "225-767-2686",
            "fax_number": "225-767-2687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 ODONOVAN",
            "address_2": "STE 102",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708087202",
            "telephone_number": "225-767-2686",
            "fax_number": "225-767-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICK",
        "first_name": "MAURICE",
        "middle_name": "MCCALL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-04",
        "last_updated": "2009-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "LA",
            "license": "009957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta Carona Vicari, M.D.
• Amara Lee Sarah Viccellio
• Vick Surgical LLC (Vick Surgical)
• Alicia McMillin Vick, PA-C
• Dawn R Vick, M.D.
• Stephanie Vick
• Stephen Randolph Vick, M.D.
• Anastasia Vicknair, LCSW
• Catherine Vicknair, MS, LPC, NCC
• Sharae Richelle Vicknair, MS

• Procedural Dermatology Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Procedural Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.