Healthcare Provider Details

I. General information

NPI: 1982224705
Provider Name (Legal Business Name): NICKOLAS COOMBS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 BEL AIR RD STE A
FALLSTON MD
21047-2755
US

IV. Provider business mailing address

2309 BEL AIR RD STE A
FALLSTON MD
21047-2755
US

V. Phone/Fax

Practice location:
  • Phone: 443-981-3130
  • Fax: 443-981-3136
Mailing address:
  • Phone: 443-981-3130
  • Fax: 443-981-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number075566
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH0105455
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: