Healthcare Provider Details

I. General information

NPI: 1306899851
Provider Name (Legal Business Name): NICHOLAS A EMILIANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 BOULEVARD SUITE B
COLONIAL HEIGHTS VA
23834-1456
US

IV. Provider business mailing address

3236 BOULEVARD SUITE B
COLONIAL HEIGHTS VA
23834-1456
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-7500
  • Fax: 804-520-5650
Mailing address:
  • Phone: 804-520-7500
  • Fax: 804-520-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101028833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: