Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 9654 | NH |
N | 2080P0201X | Pediatric Allergist | 9654 | NH |
NPI | 1457358566 |
---|---|
Provider Name | Robert Hickey |
First Address | Portsmouth, NH 03801-7158 |
Second Address | Portsmouth, NH 03801-7113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0108982Y0NH01 | ANTHEM NH ID # (01) | NH |
30009402 | (05) | NH |
G26411 | (02) | NH |