Healthcare Provider Details

I. General information

NPI: 1063616464
Provider Name (Legal Business Name): RAYMOND H HICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 GOODRICH AVE
KITTERY ME
03904
US

IV. Provider business mailing address

402 GOODRICH AVE
KITTERY ME
03904
US

V. Phone/Fax

Practice location:
  • Phone: 207-438-1000
  • Fax:
Mailing address:
  • Phone: 207-438-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number44830
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20613
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD19973
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD61314277
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: