Healthcare Provider Details

I. General information

NPI: 1972139483
Provider Name (Legal Business Name): NICOLAS ALCALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK RIDGE TPKE
OAK RIDGE TN
37830-6957
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-1093
  • Fax:
Mailing address:
  • Phone: 865-483-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number77320
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: