Healthcare Provider Details

I. General information

NPI: 1164458485
Provider Name (Legal Business Name): NICHOLAS OLIVER BIASOTTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 STANTON-CHRISTIANA RD, STE 205
NEWARK DE
19713
US

IV. Provider business mailing address

620 STANTON-CHRISTIANA RD, STE 205
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-1284
  • Fax: 302-998-1267
Mailing address:
  • Phone: 302-998-1284
  • Fax: 302-998-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0002000
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: