Provider Demographics
NPI:1619917788
Name:HICKMAN, RENEE B (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:B
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1321
Mailing Address - Country:US
Mailing Address - Phone:609-298-2005
Mailing Address - Fax:
Practice Address - Street 1:23203 COLUMBUS RD STE I
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1985
Practice Address - Country:US
Practice Address - Phone:609-303-4450
Practice Address - Fax:609-303-4451
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072498L207Q00000X
NJ25MA10235700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1301488OtherHIGHMARK
PA0018417270004Medicaid
PA047411Medicare PIN
PA1301488OtherHIGHMARK