Healthcare Provider Details

I. General information

NPI: 1154177046
Provider Name (Legal Business Name): NICHOLAS PEPEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OSTRUM ST
FOUNTAIN HILL PA
18015-1015
US

IV. Provider business mailing address

5731 RICKY RIDGE TRL
OREFIELD PA
18069-8801
US

V. Phone/Fax

Practice location:
  • Phone: 484-633-1005
  • Fax:
Mailing address:
  • Phone: 484-633-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: