Doctor Name: | MISS DOUGLAS L. HICKOK |
NPI Number: | 1356374003 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A.-C |
License Number: | 25MP00026600 |
Business Practice Address: | 1225 Whitehorse Mercerville Rd Suite 220 Mercerville, NJ - 086193882 |
Business Phone Number: | 6095812200 |
Business Fax Number: | 6095811212 |
Mailing Address: | 1225 Whitehorse Mercerville Rd, Suite 220 MERCERVILLE |
State: | NJ |
Postal Code: | 086193882 |
Phone Number: | 6095812200 |
Fax Number: | 6095811212 |
NPI Enumeration Date: | 07/08/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 25MP00026600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |