Healthcare Provider Details

I. General information

NPI: 1295861946
Provider Name (Legal Business Name): MARIA D. NIKOLAIDIS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24375 FM 1314 RD
PORTER TX
77365-4205
US

IV. Provider business mailing address

24375 FM 1314 RD
PORTER TX
77365-4205
US

V. Phone/Fax

Practice location:
  • Phone: 281-354-5663
  • Fax: 281-354-1995
Mailing address:
  • Phone: 281-354-5663
  • Fax: 281-354-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE4032
License Number StateTX

VIII. Authorized Official

Name: MARIA D. NIKOLAIDIS
Title or Position: SENIOR MEDICAL DIRECTOR
Credential: M.D.
Phone: 281-354-5663