Provider Demographics
NPI:1891149480
Name:MANSON, HICKS COREY
Entity type:Individual
Prefix:
First Name:HICKS
Middle Name:COREY
Last Name:MANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HICKS
Other - Middle Name:C
Other - Last Name:MANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:620 JOHN PAUL JONES CIRCLE
Mailing Address - Street 2:NAVY MEDICAL CENTER PORTSMOUTH
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:757-953-1813
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIRCLE
Practice Address - Street 2:NAVY MEDICAL CENTER PORTSMOUTH
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116029107207X00000X
VA0101263025207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery