Provider Demographics
NPI:1922413707
Name:HICKS, ROBIN M (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:M
Last Name:HICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 LONDONDERRY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5329
Mailing Address - Country:US
Mailing Address - Phone:717-988-0611
Mailing Address - Fax:717-231-8778
Practice Address - Street 1:4310 LONDONDERRY RD STE 109
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5329
Practice Address - Country:US
Practice Address - Phone:717-988-0611
Practice Address - Fax:717-231-8778
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018200207QH0002X
PAOT015726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103142764Medicaid