Provider Demographics
NPI:1225011521
Name:BICKEL, RICHARD ALAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:BICKEL
Suffix:JR
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 1:900 WASHINGTON RD
Mailing Address - Street 2:CREDENTIAL'S OFFICE, KELLER ARMY COMMUNITY HOSPITAL
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1109
Mailing Address - Country:US
Mailing Address - Phone:845-938-4114
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:BG 1021
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1109
Practice Address - Country:US
Practice Address - Phone:706-721-3531
Practice Address - Fax:706-721-2527
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88432207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
33025FMedicare ID - Type Unspecified
VAD000Medicare UPIN