Provider Demographics
NPI:1598253833
Name:HICKS, MARYA LINDSAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYA
Middle Name:LINDSAY
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 MARGARET LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5211
Practice Address - Country:US
Practice Address - Phone:530-274-9623
Practice Address - Fax:530-274-0590
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV21313207Q00000X
CAA175261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine