Healthcare Provider Details

I. General information

NPI: 1407213515
Provider Name (Legal Business Name): WILLIAM BEJAMIN HICKMAN IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE STE 500
WASHINGTON DC
20003-4351
US

IV. Provider business mailing address

12211 PLUM ORCHARD DR STE 220
SILVER SPRING MD
20904-7919
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-4543
  • Fax:
Mailing address:
  • Phone: 301-754-3060
  • Fax: 301-681-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD600004666
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: