Provider Demographics
NPI:1902837701
Name:HICKEY, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295C KENNEDY MEMORIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4535
Mailing Address - Country:US
Mailing Address - Phone:207-873-5437
Mailing Address - Fax:207-872-6037
Practice Address - Street 1:295C KENNEDY MEMORIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4535
Practice Address - Country:US
Practice Address - Phone:207-873-5437
Practice Address - Fax:207-872-6037
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM8887Medicare ID - Type Unspecified
MEH39316Medicare UPIN