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NPI Code Detail

MEDICARE: CHARLES B HICKOK MD

MEDICARE: CHARLES B HICKOK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianD0039728MD

General Provider Information

NPI Number : 1720066277
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES B HICKOK MD
Provider Business Mailing Address
First Line : 150 BLUFF AVE
Second Line :
City : NORTH AUGUSTA
State : SC
Zip : 29841-3862
Country : US
Telephone Number : 800-394-4445
Fax Number :
Provider Business Practice Location Address
First Line : 8118 GOOD LUCK RD
Second Line :
City : LANHAM
State : MD
Zip : 20706-3574
Country : US
Telephone Number : 301-952-1370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 01/17/2017

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