Provider Demographics
NPI:1417014804
Name:HICKS, ALLYSON D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:D
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALLYSON
Other - Middle Name:MCCORMICK
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-737-9240
Mailing Address - Fax:401-739-6413
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-737-9240
Practice Address - Fax:401-739-6413
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI08394MD208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAH01324Medicaid
RIAH01324Medicaid