Provider Demographics
NPI:1386617157
Name:HICKS, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVENUE
Mailing Address - Street 2:URMC BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-3184
Mailing Address - Fax:585-276-2802
Practice Address - Street 1:601 ELMWOOD AVENUE
Practice Address - Street 2:UNIVERSITY OF ROCHESTER MEDICAL CENTER, BOX 626
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3184
Practice Address - Fax:585-276-2802
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY183009207ZP0101X
NY183009-1207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026229002OtherUNIVERA INS. #