Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS003496L | PA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OS003496L | PA |
NPI | 1639171598 |
---|---|
Provider Name | Alexander S. Nicholas |
First Address | Philadelphia, PA 19131-1626 |
Second Address | Philadelphia, PA 19131-1626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 01/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000700018 | (05) | PA |
D98754 | (02) |