Provider Demographics
NPI:1356376289
Name:HICKEY, DERRICK GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:GERARD
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 1:6101 OLD BRANCH RD
Mailing Address - Street 2:C/O D. HICKEY, PRESIDENT, PORT CITY ORTHOPAEDICS PLLC
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409
Mailing Address - Country:US
Mailing Address - Phone:910-791-4492
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:206 CAUSEWAY DR UNIT 232
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-1759
Practice Address - Country:US
Practice Address - Phone:910-791-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201100207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2321012OtherUNITED HEALTH CARE
P00341370OtherMEDICARE RAILROAD
189631OtherMEDCOST
NC134C0OtherBCBS
1132227OtherCIGNA
7107507OtherAETNA
NC89134C0Medicaid
NC89134C0Medicaid