Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD024170E | PA |
N | 208000000X | Pediatrician | MD024170E | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD024170E | PA |
NPI | 1255344438 |
---|---|
Provider Name | Susan C Nicolson |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 11/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009928990 | (05) | PA |
097501EMD | MEDICARE PTAN CCM (01) | PA |
097501J6Z | MEDICARE PTAN PAIN MANAGEMENT (01) | PA |
181300EJL | MEDICARE PTAN (01) | PA |
B36280 | (02) | PR |