Provider Demographics
NPI:1033199898
Name:HICKS, TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-320-2483
Mailing Address - Fax:804-419-1860
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-320-2483
Practice Address - Fax:804-419-1860
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051067207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000133671506OtherUNITED
11938OtherCARENET
94539OtherSOUTHERN HEALTH
VAC09633OtherGROUP PTAN
6201083OtherVA PREMIER
226116OtherANTHEM
541941044102OtherTRICARE
160049264OtherRR MEDICARE
330713OtherMAMSI
69493OtherOPTIMA HEALTH
VA006201083Medicaid
69493OtherSENTARA
9276110OtherCIGNA
0861892OtherAETNA USHEALTH
94539OtherSOUTHERN HEALTH
11938OtherCARENET