Provider Demographics
NPI:1073516605
Name:HICKMAN, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:HICKMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2149
Mailing Address - Country:US
Mailing Address - Phone:740-362-8686
Mailing Address - Fax:740-833-3084
Practice Address - Street 1:90 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2149
Practice Address - Country:US
Practice Address - Phone:740-362-8686
Practice Address - Fax:740-833-3084
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076870H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256866Medicaid
OHH33826Medicare UPIN
OH2256866Medicaid