Provider Demographics
NPI:1598736142
Name:HICKS, CHRISTOPHER MAHOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MAHOOD
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21672
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0169
Mailing Address - Country:US
Mailing Address - Phone:540-904-7534
Mailing Address - Fax:540-904-7545
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:SUITE 2130
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-444-4670
Practice Address - Fax:540-444-4671
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101036424208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009262L84Medicare ID - Type UnspecifiedRICHMOND MEDICARE
E27516Medicare UPIN