Provider Demographics
NPI:1225323710
Name:BICK, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:BICK
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 1:148 W RIVER ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2615
Mailing Address - Country:US
Mailing Address - Phone:401-728-0140
Mailing Address - Fax:401-727-1979
Practice Address - Street 1:148 W RIVER ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2615
Practice Address - Country:US
Practice Address - Phone:401-728-0140
Practice Address - Fax:401-727-1979
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15376207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology