Healthcare Provider Details

I. General information

NPI: 1922068493
Provider Name (Legal Business Name): MICHAEL S NICKELS M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S QUEEN ST
YORK PA
17403-4637
US

IV. Provider business mailing address

1620 S QUEEN ST
YORK PA
17403-4637
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-6663
  • Fax: 717-852-0670
Mailing address:
  • Phone: 717-843-6663
  • Fax: 717-852-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD424414
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: