Healthcare Provider Details

I. General information

NPI: 1568752954
Provider Name (Legal Business Name): DENNIS DURAND HICKSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR BLDG 10/CRC, ROOM 3-3142
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10 CENTER DR BLDG 10/CRC, ROOM 3-3142
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-594-1718
  • Fax: 301-402-5054
Mailing address:
  • Phone: 301-594-1718
  • Fax: 301-402-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD 00019806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: