MEDICARE: NIKOLAS DOTOLO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1235758780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLAS DOTOLO

Provider Business Mailing Address
First Line	:	811 GALE LN APT 123
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3019
Country	:	US
Telephone Number	:	978-854-2905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 BELMONT BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3757
Country	:	US
Telephone Number	:	615-460-8122
Fax Number	:

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/15/2020

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Directions to “ NIKOLAS DOTOLO ” Practice Location

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