Provider Demographics
NPI:1558484493
Name:HICKS, CHARLES WILLIAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:HICKS
Suffix:III
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 1:8831 SATYR HILL RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2306
Mailing Address - Country:US
Mailing Address - Phone:410-661-9250
Mailing Address - Fax:
Practice Address - Street 1:8831 SATYR HILL RD
Practice Address - Street 2:SUITE 211
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-2306
Practice Address - Country:US
Practice Address - Phone:410-661-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00326702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD395781100Medicaid
MDD77727Medicare UPIN