Healthcare Provider Details

I. General information

NPI: 1215416607
Provider Name (Legal Business Name): NICHOLAS KOBUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 HONEYGO BLVD STE 127
NOTTINGHAM MD
21236-5905
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY STE 301
BURBANK CA
91505-5025
US

V. Phone/Fax

Practice location:
  • Phone: 443-330-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: