Healthcare Provider Details

I. General information

NPI: 1285628180
Provider Name (Legal Business Name): NICCOLE M OSWALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICCOLE M MAMBU MD

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 MAIN ST
SILVERDALE PA
18962
US

IV. Provider business mailing address

PO BOX 420
SILVERDALE PA
18962-0420
US

V. Phone/Fax

Practice location:
  • Phone: 215-258-3810
  • Fax: 215-258-3815
Mailing address:
  • Phone: 215-258-3810
  • Fax: 833-616-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD418021
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: