Provider Demographics
NPI:1902143811
Name:HICKEY, SERGIO (MD)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:GIRALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVE
Mailing Address - Street 2:FORBES TOWER - PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:503-396-1450
Mailing Address - Fax:
Practice Address - Street 1:3471 FIFTH AVE
Practice Address - Street 2:KAUFMANN BUILDING SUITE 910
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:757-953-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101256741208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program