Provider Demographics
NPI:1417290339
Name:HICKMAN, LISA CARONIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CARONIA
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CARONIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4243
Mailing Address - Fax:614-814-8530
Practice Address - Street 1:6100 N HAMILTON RD FL 3
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2062
Practice Address - Country:US
Practice Address - Phone:614-293-4243
Practice Address - Fax:614-814-8530
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131630207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery