Healthcare Provider Details

I. General information

NPI: 1225011521
Provider Name (Legal Business Name): RICHARD ALAN BICKEL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST BG 1021
AUGUSTA GA
30912-1109
US

IV. Provider business mailing address

900 WASHINGTON RD CREDENTIAL'S OFFICE, KELLER ARMY COMMUNITY HOSPITAL
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3531
  • Fax: 706-721-2527
Mailing address:
  • Phone: 845-938-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number88432
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: