Provider Demographics
NPI:1619961364
Name:HICKS, ROBIN P (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:P
Last Name:HICKS
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 1:125 NEWBURY ST
Mailing Address - Street 2:#300
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4592
Mailing Address - Country:US
Mailing Address - Phone:508-879-5764
Mailing Address - Fax:508-820-0864
Practice Address - Street 1:125 NEWBURY ST
Practice Address - Street 2:#300
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4592
Practice Address - Country:US
Practice Address - Phone:508-879-5764
Practice Address - Fax:508-820-0864
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA153221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3171116Medicaid