Healthcare Provider Details

I. General information

NPI: 1700959590
Provider Name (Legal Business Name): NICHOLAS LANCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 MCCORMICK DR STE 101
CLEARWATER FL
33759-1075
US

IV. Provider business mailing address

330 3RD ST S UNIT 1101
ST PETERSBURG FL
33701-4271
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-4848
  • Fax: 727-842-9513
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME129371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: