MEDICARE: DR. NIKOLINA DIOUFA MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MT213100	PA

General Provider Information

NPI Number	:	1073041513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKOLINA DIOUFA MD, PHD

Provider Business Mailing Address
First Line	:	3400 N BROAD ST STE 840
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5104
Country	:	US
Telephone Number	:	215-707-8995
Fax Number	:	215-707-2738

Provider Business Practice Location Address
First Line	:	3400 N BROAD ST STE 840
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5104
Country	:	US
Telephone Number	:	215-707-8995
Fax Number	:	215-707-2738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2017
Last Update Date	:	07/21/2022

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