Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101025325 | VA |
N | 207KA0200X | Allergist | MD3203 | DC |
NPI | 1467412510 |
---|---|
Provider Name | Dr. Richard A. Nicklas |
First Address | Fairfax, VA 22031-5218 |
Second Address | Reston, VA 20190-3236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 03/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B93786 | (02) |