Provider Demographics
NPI:1902838329
Name:FICKES, JOSEPH FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FREDERICK
Last Name:FICKES
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 1:51 MERWINS LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1972
Mailing Address - Country:US
Mailing Address - Phone:203-259-6878
Mailing Address - Fax:
Practice Address - Street 1:51 MERWINS LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-1972
Practice Address - Country:US
Practice Address - Phone:203-319-0733
Practice Address - Fax:203-319-0733
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0324842084P0800X, 2084P0805X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001324847Medicaid
CT260003099Medicare ID - Type Unspecified
CT001324847Medicaid