Provider Demographics
NPI:1407812282
Name:HICKEY, DONALD DOUGLAS (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DOUGLAS
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 803
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-0803
Mailing Address - Country:US
Mailing Address - Phone:716-839-5474
Mailing Address - Fax:716-839-4090
Practice Address - Street 1:4476 MAIN STREET
Practice Address - Street 2:STE 104
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-5474
Practice Address - Fax:716-839-4090
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138795208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01136685Medicaid
C57904Medicare UPIN
NY033631Medicare ID - Type Unspecified