Provider Demographics
NPI:1073682084
Name:HICKHAM, PATRICIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:R
Last Name:HICKHAM
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 1:4141 BIENVILLE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5149
Mailing Address - Country:US
Mailing Address - Phone:504-962-7771
Mailing Address - Fax:
Practice Address - Street 1:4141 BIENVILLE ST STE 108
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-962-7771
Practice Address - Fax:504-962-7776
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22278207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1491446Medicaid
LAG90759Medicare UPIN
LA1491446Medicaid