1598736142 NPI number — DR. CHRISTOPHER MAHOOD HICKS MD

Table of content: DR. CHRISTOPHER MAHOOD HICKS MD (NPI 1598736142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598736142 NPI number — DR. CHRISTOPHER MAHOOD HICKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
MAHOOD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598736142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21672
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-0169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-904-7534
Provider Business Mailing Address Fax Number:
540-904-7545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1802 BRAEBURN DR
Provider Second Line Business Practice Location Address:
SUITE 2130
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153-7357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-444-4670
Provider Business Practice Location Address Fax Number:
540-444-4671
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  0101036424 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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