Provider Demographics
NPI:1659636439
Name:ROYCE-HICKEY, REBECCA (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:ROYCE-HICKEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:1072 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1538
Practice Address - Country:US
Practice Address - Phone:610-838-7069
Practice Address - Fax:610-838-7060
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017502207Q00000X
PAOT014459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine