Healthcare Provider Details

I. General information

NPI: 1003298118
Provider Name (Legal Business Name): NIKHIL CHINMAYA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 S 4TH ST
PHILADELPHIA PA
19147-5928
US

IV. Provider business mailing address

1428 S 4TH ST
PHILADELPHIA PA
19147-5928
US

V. Phone/Fax

Practice location:
  • Phone: 302-339-0644
  • Fax: 844-670-3220
Mailing address:
  • Phone: 302-339-0644
  • Fax: 844-670-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB11436600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS019362
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: