Healthcare Provider Details

I. General information

NPI: 1912065392
Provider Name (Legal Business Name): ROBERT G HICKES MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 CLIFF ST
ITHACA NY
14850-2017
US

IV. Provider business mailing address

821 CLIFF ST
ITHACA NY
14850-2017
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-5486
  • Fax: 607-272-5966
Mailing address:
  • Phone: 607-272-5486
  • Fax: 607-272-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number113067
License Number StateNY

VIII. Authorized Official

Name: ROBERT G HICKES
Title or Position: OWNER
Credential: M.D,
Phone: 607-272-5486