Healthcare Provider Details

I. General information

NPI: 1902838329
Provider Name (Legal Business Name): JOSEPH FREDERICK FICKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MERWINS LN
FAIRFIELD CT
06824-1972
US

IV. Provider business mailing address

51 MERWINS LN
FAIRFIELD CT
06824-1972
US

V. Phone/Fax

Practice location:
  • Phone: 203-319-0733
  • Fax: 203-319-0733
Mailing address:
  • Phone: 203-259-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number032484
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number032484
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number032484
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: