Healthcare Provider Details

I. General information

NPI: 1356376289
Provider Name (Legal Business Name): DERRICK GERARD HICKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CAUSEWAY DR UNIT 232
WRIGHTSVILLE BEACH NC
28480-1759
US

IV. Provider business mailing address

6101 OLD BRANCH RD C/O D. HICKEY, PRESIDENT, PORT CITY ORTHOPAEDICS PLLC
WILMINGTON NC
28409
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-4492
  • Fax:
Mailing address:
  • Phone: 910-791-4492
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number200201100
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number200201100
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: