Healthcare Provider Details

I. General information

NPI: 1689812406
Provider Name (Legal Business Name): NICOLE A CHIOTA-MCCOLLUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

2150 HARRISBURG PIKE STE 200A
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-396-9167
  • Fax: 717-396-9064
Mailing address:
  • Phone: 717-396-9167
  • Fax: 717-396-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD474880
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD474880
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: