Provider Demographics
NPI:1972677680
Name:HICKS, THOMAS KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:HICKS
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 1:22B LEE ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3215
Mailing Address - Country:US
Mailing Address - Phone:508-769-0718
Mailing Address - Fax:
Practice Address - Street 1:103 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01022-1063
Practice Address - Country:US
Practice Address - Phone:413-593-4000
Practice Address - Fax:423-593-4097
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA589792083X0100X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine