Active NPI
Susan Holly Wicke, M.D.
- Psychiatry Physician
- Durham, NC
National Provider Identifier
1912063900
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Aug 20, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 36618
- Practice address
- 112 Swift Ave
Durham, NC 27705 - Phone
- (919) 308-6076
- Fax
- (919) 308-6076
- NPI assigned
- Dec 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 36618 | NC | Primary |
Addresses
Primary practice location
112 Swift Ave
Durham, NC 27705
Mailing address
112 Swift Ave
Durham, NC 27705
Phone (919) 308-6076
Other names 1
- Susan Wicke
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36618 | NC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374796800000",
"number": "1912063900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 SWIFT AVE",
"city": "DURHAM",
"state": "NC",
"postal_code": "27705",
"telephone_number": "919-308-6076",
"fax_number": "919-308-6076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 SWIFT AVE",
"city": "DURHAM",
"state": "NC",
"postal_code": "27705",
"telephone_number": "919-308-6076",
"fax_number": "919-308-6076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKE",
"first_name": "SUSAN",
"middle_name": "HOLLY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-28",
"last_updated": "2013-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "36618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "WICKE",
"credential": "M.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Durham, NC
- Whole Life OT, PLLC
- Wholehearted Psychotherapy PLLC (Wholehearted Psychotherapy)
- Wholistic Transformation, LLC
- Anna Noelle Wichlinski, AUD
- Bethany Wichman-Buescher, LCSWA
- Julia K. Wickel, PA
- Sharon R Wickel, R.D.,LDN,CDE
- Natalie Elise Wickenheisser
- Wickham Health and Wellness (FYZICAL Therapy & Balance Centers)
- Melissa Wickham, OTR/L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.