Healthcare Provider Details

I. General information

NPI: 1023638681
Provider Name (Legal Business Name): NICHOLAS NOVERATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHESTNUT ST FL 8
PHILADELPHIA PA
19107-3612
US

IV. Provider business mailing address

1101 CHESTNUT ST FL 8
PHILADELPHIA PA
19107-3612
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax:
Mailing address:
  • Phone: 215-955-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25IA13007000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD479030
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: