Provider Demographics
NPI:1659477131
Name:BYCK, HAL C (MD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:C
Last Name:BYCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:NEMOURS PEDIATRICS JESSUP ST.
Practice Address - Street 2:1602 JESSUP STREET
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-4210
Practice Address - Country:US
Practice Address - Phone:302-576-5050
Practice Address - Fax:302-576-5065
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10003946208000000X, 208D00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5607400Medicaid
VA6704204Medicaid
PA001447101Medicaid
DC4423030Medicaid
MD1484311Medicaid
VA6704204Medicaid
001021T34Medicare PIN