Provider Demographics
NPI:1083665806
Name:HICKS, LEROI S (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LEROI
Middle Name:S
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:501 W. 14TH STREET
Practice Address - Street 2:WILMINGTON HOSPITAL, 2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-428-4411
Practice Address - Fax:302-428-4078
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA152379207R00000X, 208M00000X
DEC1-0010876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA30746Medicare PIN