Look up the most recent NPI and PECOS records

Robert Dickerson

Internal Medicine

Allopathic & Osteopathic Physicians

PECOS Enrollment

Based on the most recent information from CMS, provider Robert Dickerson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1326070590
Provider Type
Individual
Full Name
Dickerson, Robert
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
7/7/2006
Last Updated
4/10/2014

Contact Information

Practice Location

324 E 112, 6b, New York City, NY 10029

(212) 879-5168

Mailing Location

33 E. 125th St., New York, NY 10027

(212) 879-5168

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 151361 New York

Provider Identifiers

ID	Description	Issuer
ID 01672999	Description Medicaid	Issuer Unlisted New York

Robert Dickerson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Yusuf, Marwan Nihad Abdel Rauf

Duenas, Maria I

Sow, Sire

Lucky Care Medical, Pc

Tao, Chenguang Tony

Domek, Maciej

Van Woert, Melvin H

Small, Katherine Morgan

Zhang, Meng

Blum, Cary Julian