Healthcare Provider Details

I. General information

NPI: 1497335798
Provider Name (Legal Business Name): LORIE-MAE NICOLAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WALNUT ST STE 205
LEMOYNE PA
17043-1168
US

IV. Provider business mailing address

3 WALNUT ST STE 205
LEMOYNE PA
17043-1168
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-0090
  • Fax: 717-221-5320
Mailing address:
  • Phone: 717-988-0090
  • Fax: 717-221-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD484805
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD484805
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD484805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: