Healthcare Provider Details

I. General information

NPI: 1982136594
Provider Name (Legal Business Name): CHRISTIAN NILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GOOD HOPE RD
ENOLA PA
17025-1210
US

IV. Provider business mailing address

2200 GOOD HOPE RD
ENOLA PA
17025-1210
US

V. Phone/Fax

Practice location:
  • Phone: 717-981-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD89195
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD476892
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: