Provider Demographics
NPI:1104855394
Name:HICKEY, ANDREW EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:EDWARD
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-2111
Mailing Address - Country:US
Mailing Address - Phone:717-244-8627
Mailing Address - Fax:
Practice Address - Street 1:445 S PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-2111
Practice Address - Country:US
Practice Address - Phone:717-244-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD01305E207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12739OtherJOHNS HOPKINS
PA998048OtherUPMC
PA000641857Medicaid
PA76586OtherGEISINGER
PAP004692OtherGATEWAY-WMG
PA191576OtherHIGHMARK BLUE SHIELD
PA5336310OtherAETNA
PA20005817OtherAMERIHEALTH MERCY-WMG
PAC27902Medicare UPIN
PA080175924Medicare PIN
PA76586OtherGEISINGER