Provider Demographics
NPI:1336104835
Name:HICKEY, MICHAEL G (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HICKEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:VIRIGNIA EMERGENCY ASSOCIATES INC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:1402 MAIN ST
Practice Address - Street 2:DRMC ED
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24145
Practice Address - Country:US
Practice Address - Phone:804-287-7066
Practice Address - Fax:804-673-9531
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840453207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110840453OtherBOARD OF MEDICINE