Healthcare Provider Details

I. General information

NPI: 1447570296
Provider Name (Legal Business Name): RENEE HICKEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY BUILDING 11
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

34 PARSONAGE ST
PROVIDENCE RI
02903-4732
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-1860
  • Fax: 401-444-3205
Mailing address:
  • Phone: 401-444-7638
  • Fax: 401-444-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD14670
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: